Provider Information for 1730619859
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RONALD ROBERT JOHNSON LCAS (Registered)
Sex: Male
NPI: 1730619859
Last Updated: 2018-06-20
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1730619859 | ||||||||||||
| Enumeration Date | 2017-06-13 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 3111 LONG MEADOW CT APT 203 RALEIGH, NC 27613-3216 United States Phone: 919-436-0413 | Fax: | ||||||||||||
| Primary Practice Address | 3826 BLAND RD RALEIGH, NC 27609 United States Phone: 919-872-1441 | Fax:919-872-1455 | ||||||||||||
| Secondary Practice Address(es) | 3824 BARRETT DR STE 105 | ||||||||||||
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