Organization Name: | SIDNEY P JOHNSON, M.D. P.C |
NPI Number: | 1396934659 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PHYLLIS GRIFFIN (INSURANCE MANAGER) |
Mailing Address: | 11 Johnson St Hazlehurst |
State: | GA US |
Postal Code: | 315396243 |
Phone Number: | 9123752521 |
Fax Number: | |
NPI Enumeration Date: | 10/23/2007 |
NPI Last Update Date: | 10/23/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 10971 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |