Healthcare Provider Details

I. General information

NPI: 1841219631
Provider Name (Legal Business Name): MONICA MANIGO-JOHNSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 WHISKEY RD
AIKEN SC
29803-6197
US

IV. Provider business mailing address

2741 WHISKEY RD
AIKEN SC
29803-6197
US

V. Phone/Fax

Practice location:
  • Phone: 803-226-0217
  • Fax: 803-226-0459
Mailing address:
  • Phone: 803-226-0217
  • Fax: 803-226-0459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number000695
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: