MEDICARE: JEB STUART JOHNSTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach	A-3691813

General Provider Information

NPI Number	:	1538908397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEB STUART JOHNSTON

Provider Business Mailing Address
First Line	:	5214 LANCASTER ST
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-4132
Country	:	US
Telephone Number	:	443-804-4841
Fax Number	:

Provider Business Practice Location Address
First Line	:	5214 LANCASTER ST
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-4132
Country	:	US
Telephone Number	:	443-804-4841
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2024
Last Update Date	:	05/22/2024

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Directions to “ JEB STUART JOHNSTON ” Practice Location

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