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General NPI Number Information
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NPI Number | 1407748676
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Entity Type | Individual
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Provider Name | JADE ANGELIQUE JOHNSON-GRANT
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Gender | Female
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 1368 PINEY GREEN RD STE 4
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City | JACKSONVILLE
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State | NC
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Zip | 28546-4577
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Country | US
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Telephone | 910-777-9598
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Fax |
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Provider Business Mailing Address
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Address Line | 1002 SUMMERBROOK PL
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City | JACKSONVILLE
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State | NC
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Zip | 28540-3838
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Country | US
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Telephone | 910-777-9598
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 22716
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License Number State | NC
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