Healthcare Provider Details

I. General information

NPI: 1487630018
Provider Name (Legal Business Name): JOHNSON FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 WARM SPRINGS RD
COLUMBUS GA
31904-5637
US

IV. Provider business mailing address

PO BOX 138
COLUMBUS GA
31902-0138
US

V. Phone/Fax

Practice location:
  • Phone: 706-327-4797
  • Fax: 706-324-4131
Mailing address:
  • Phone: 706-327-4797
  • Fax: 706-324-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: C DENTON JOHNSON
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 706-327-4797