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General NPI Number Information
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NPI Number | 1043714264
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Entity Type | Individual
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Provider Name | CARL EDWARD JOHNS III DO
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Gender | Male
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 5001 HARDY ST
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City | HATTIESBURG
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State | MS
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Zip | 39402-1308
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Country | US
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Telephone | 601-296-3963
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Fax |
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Provider Business Mailing Address
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Address Line | 14940 SE 140TH AVENUE RD
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City | WEIRSDALE
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State | FL
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Zip | 32195-2203
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Country | US
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Telephone | 321-431-8285
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 28051
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License Number State | MS
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