Healthcare Provider Details

I. General information

NPI: 1992191746
Provider Name (Legal Business Name): CHRISTOPHER JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E 6TH ST STE 606
PANAMA CITY FL
32401-3645
US

IV. Provider business mailing address

4205 BELFORT RD STE 4015
JACKSONVILLE FL
32216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 850-913-6960
  • Fax: 850-913-6961
Mailing address:
  • Phone: 904-450-6063
  • Fax: 904-539-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberME151595
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: