Individual ProviderJohnathan Donald DebettaPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address4350 Us 421 S, Lillington, NC 27546-6760(910) 893-1210(631) 678-8049PECOS EnrollmentBased on the most recent information from CMS, provider Johnathan Donald Debetta does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1164003570Provider TypeIndividualFull NameDebetta, Johnathan DonaldGenderMaleSole ProprietorNoEnumeration Date4/16/2021Last Updated12/7/2021Contact InformationPractice LocationPractice Address4350 Us 421 S, Lillington, NC 27546-6760Phone(910) 893-1210FaxUnlisted FaxMailing LocationMailing Address10118 Knotty Pine Ln, Raleigh, NC 27617-8218Phone(631) 678-8049FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense0010-11534North Carolina