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General NPI Number Information
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NPI Number | 1295335073
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Entity Type | Individual
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Provider Name | JARED JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 1009 SAINT PATRICKS DR
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City | PERRY
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State | GA
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Zip | 31069-2144
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Country | US
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Telephone | 478-987-2323
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Fax |
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Provider Business Mailing Address
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Address Line | 204 CRYSTAL DR
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City | BYRON
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State | GA
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Zip | 31008-7321
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Country | US
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Telephone | 770-298-7902
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH028973
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License Number State | GA
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