FL NEURO PAIN AND SPINE CENTER, P.A.
Ambulatory Health at Jenks Ave, Panama City, FL

License number
Florida CH 10072
Category
Ambulatory Health
Type
Health Service
Owner
Name: DR. WESLEY J JOHNSON
Title: PRESIDENT
Phone: (850) 624-2973
Address
Address
1008 Jenks Ave, Panama City, FL 32401
National Provider ID: 1194034397
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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FL NEURO PAIN AND SPINE CENTER, PA

Panama City, FL

Status:
Inactive
Inactive reason:
NAME CHANGE AMENDMENT
Registration:
Sep 17, 2010
Inactive since:
Sep 16, 2013
Addresses:
1008 Jenks Ave, Panama City, FL 32401 (Physical)
725 Balboa Ave, Panama City, FL 32401
State ID:
P10000076520
Business type:
Florida Profit Corporation
Vice Presidents:
Wesley Johnson (President, Director), 1008 Jenks Ave, Panama City, FL 32401 (Physical),James W. Johnson Vice President, inactive
Agent:
Pyne Law Group,Pyne Law Group, Panama City, FL 32401 (Physical)
EIN:
80-0646626

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