| Doctor Name: | DR. EDDIE GLEN JOHNSON |
| NPI Number: | 1962738500 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 013312 |
| Business Practice Address: | 7330 Fern Ave Ste 1103 Shreveport, LA - 711054989 |
| Business Phone Number: | 3187980635 |
| Business Fax Number: | |
| Mailing Address: | 107 Grayson Cir, BOSSIER CITY |
| State: | LA |
| Postal Code: | 711128605 |
| Phone Number: | 3184582756 |
| Fax Number: | |
| NPI Enumeration Date: | 11/01/2009 |
| NPI Last Update Date: | 11/01/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 013312 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |