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NPI Code Detail

MEDICARE: DR. MICHAEL REESE JOHNSON M.D.

MEDICARE: DR. MICHAEL REESE JOHNSON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician08570MS

General Provider Information

NPI Number : 1144281262
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL REESE JOHNSON M.D.
Provider Business Mailing Address
First Line : 1134 WINTER ST
Second Line :
City : JACKSON
State : MS
Zip : 39204-2841
Country : US
Telephone Number : 601-948-5572
Fax Number : 601-353-7070
Provider Business Practice Location Address
First Line : 1134 WINTER ST
Second Line :
City : JACKSON
State : MS
Zip : 39204-2841
Country : US
Telephone Number : 601-948-5572
Fax Number : 601-353-7070
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2006
Last Update Date : 07/08/2007

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