Provider Demographics
NPI:1285305797
Name:WILSON-JOHNSON, RACHEL L
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:L
Last Name:WILSON-JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120A E 5TH NORTH ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6822
Mailing Address - Country:US
Mailing Address - Phone:843-934-1968
Mailing Address - Fax:888-298-0519
Practice Address - Street 1:120A E 5TH NORTH ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6822
Practice Address - Country:US
Practice Address - Phone:843-934-1968
Practice Address - Fax:888-298-0519
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRBT-20-149545247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other