Glen F Johnson, PA
Physician Assistant in Fayetteville, NC. Individual provider (NPI-1).
NPI number1619971561
StatusActive
Last updated in NPPESFeb 13, 2008
Details
- NPI
- 1619971561
- Entity type
- Individual (NPI-1)
- Name
- Glen F Johnson
- Credential
- PA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 9, 2005
- Last updated
- Feb 13, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 00010366 | NC | Yes |
Practice location
524 Beaumont RdFayetteville, NC 28304-4443
Phone 800-476-8646
Mailing address
Po Box 1070Charlotte, NC 28201-1070
Phone 800-476-8646 · Fax 919-382-3210
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