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General NPI Number Information
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NPI Number | 1902226236
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Entity Type | Individual
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Provider Name | MS. HEATHER JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 04/25/2014
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 1050 REGISTER ST
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City | CHARLESTON
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State | SC
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Zip | 29405-2421
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Country | US
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Telephone | 438-308-9662
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 REGISTER ST
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City | NORTH CHARLESTON
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State | SC
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Zip | 29405-2421
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Country | US
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Telephone | 843-308-9662
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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 | 1710I1002X
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Taxonomy Name | Independent Duty Corpsman
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License Number |
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License Number State |
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