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General NPI Number Information
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NPI Number | 1407019771
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Entity Type | Organization
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Legal Business Name | WILLIAM R. JOHNSON, PH.D., PC
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 1421 LEE ST
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City | BRUNSWICK
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State | GA
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Zip | 31520-7132
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Country | US
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Telephone | 912-265-0007
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Fax | 912-261-0593
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Provider Business Mailing Address
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Address Line | 1421 LEE ST
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City | BRUNSWICK
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State | GA
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Zip | 31520-7132
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Country | US
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Telephone | 912-265-0007
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Fax | 912-261-0593
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | DR. WILLIAM R JOHNSON
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Credential | PH.D.
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Telephone | 912-265-0007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY000541
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License Number State | GA
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