Johnny B'S, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

JOHNNY B'S, LLC

Practice address

2020 Remount Rd
Gastonia, NC 28054-7476

Phone

(704) 779-3275

NPI assigned

Aug 29, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Vivian Wideman

Title

Owner

Phone

(704) 779-3275

Specialties & licenses 1

Addresses

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662076800000",
    "number": "1578283727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 REMOUNT RD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280547476",
            "telephone_number": "704-779-3275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 REMOUNT RD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280547476",
            "telephone_number": "704-779-3275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNNY B'S, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-29",
        "last_updated": "2022-09-02",
        "certification_date": "2022-09-02",
        "status": "A",
        "authorized_official_last_name": "WIDEMAN",
        "authorized_official_first_name": "VIVIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-779-3275"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "johnnybs6720@gmail.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2020 Remount Rd",
            "city": "Gastonia",
            "state": "NC",
            "country_code": "US",
            "postal_code": "280547476",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Revonda Lashawn Jessup, D.P.M.
• Kathryn Ellen Page Jeyatheva
• John a. Lyons, DDS, PA
• John Walsh DDS PA
• Unknown Anup Johney, PT
• Amelia Barron Johnson, LPC
• Ashley Johnson, PHARMD
• Benjamin Dawsey Johnson, PSY.D.
• Cameron Johnson
• Crystal Kay Johnson, RD

• Community/Behavioral Health Agency in Gastonia, NC
• Providers in Gastonia, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.