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General NPI Number Information
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NPI Number | 1053315028
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Entity Type | Individual
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Provider Name | WILLIAM WALTER JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 07/28/2021
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Provider Practice Location Address
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Address Line | 1935 LAKELAND DR STE 900
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City | JACKSON
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State | MS
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Zip | 39216-5028
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Country | US
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Telephone | 601-840-1454
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Fax |
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Provider Business Mailing Address
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Address Line | 536 ROYAL PECAN WAY
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City | COLLIERVILLE
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State | TN
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Zip | 38017-1734
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Country | US
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Telephone | 662-538-8009
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 14886
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | 14886
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License Number State | MS
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