Healthcare Provider Details

I. General information

NPI: 1619081346
Provider Name (Legal Business Name): RICHARD SCOTT JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 MARION AVE
MCCOMB MS
39648-2705
US

IV. Provider business mailing address

PO BOX 490
MCCOMB MS
39649-0490
US

V. Phone/Fax

Practice location:
  • Phone: 601-249-1382
  • Fax: 601-249-1751
Mailing address:
  • Phone: 769-231-7371
  • Fax: 601-250-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number18112
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: