Provider Demographics
NPI:1821108630
Name:SAWYER, JOHNATHAN ERIC (PAC)
Entity Type:Individual
Prefix:MR
First Name:JOHNATHAN
Middle Name:ERIC
Last Name:SAWYER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WARD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SWANSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28584-8266
Mailing Address - Country:US
Mailing Address - Phone:252-326-3742
Mailing Address - Fax:
Practice Address - Street 1:205 WARD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-8266
Practice Address - Country:US
Practice Address - Phone:252-326-3742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000402363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant