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General NPI Number Information
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NPI Number | 1043874225
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Entity Type | Individual
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Provider Name | GEORGE MICHAEL JOHNSON DO
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Gender | Male
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 2104 MASSEY AVENUE
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City | JACKSONVILLE
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State | FL
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Zip | 32228
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Country | US
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Telephone | 904-270-4265
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Fax |
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Provider Business Mailing Address
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Address Line | 7751 LISA DR E
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City | JACKSONVILLE
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State | FL
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Zip | 32217-4134
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Country | US
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Telephone | 615-815-4834
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | OS19146
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License Number State | FL
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