Provider Demographics
NPI:1376895458
Name:JOHNSON, RODNEY JR
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28335-0183
Mailing Address - Country:US
Mailing Address - Phone:910-292-2130
Mailing Address - Fax:910-292-2135
Practice Address - Street 1:600 S MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5825
Practice Address - Country:US
Practice Address - Phone:910-292-2130
Practice Address - Fax:910-292-2135
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16669344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi