Provider Demographics
NPI:1700690450
Name:CANTRELL, JOHNNY MARTIN JR (HIS)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:MARTIN
Last Name:CANTRELL
Suffix:JR
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 HENDERSONVILLE RD STE 30
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-5520
Mailing Address - Country:US
Mailing Address - Phone:828-585-5852
Mailing Address - Fax:
Practice Address - Street 1:4110 HENDERSONVILLE RD STE 30
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-5520
Practice Address - Country:US
Practice Address - Phone:828-585-5852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1339A01237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist