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NPI Code Detail

MEDICARE: DR. ROBERT WILLIAM JOHNSON M.D.

MEDICARE: DR. ROBERT WILLIAM 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
12086S0129XVascular Surgery Physician015209GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467450742
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT WILLIAM JOHNSON M.D.
Provider Business Mailing Address
First Line : PO BOX 31258
Second Line : ATTN. CONTRACT PHYSICIAN SERVICES
City : AUGUSTA
State : GA
Zip : 30903-3058
Country : US
Telephone Number : 706-828-2365
Fax Number : 706-774-7243
Provider Business Practice Location Address
First Line : 1350 WALTON WAY
Second Line : WOUND AND HYPERBARIC
City : AUGUSTA
State : GA
Zip : 30901-2612
Country : US
Telephone Number : 706-774-7242
Fax Number : 706-774-7243
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 02/03/2014

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