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General NPI Number Information
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NPI Number | 1467450742
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Entity Type | Individual
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Provider Name | ROBERT WILLIAM JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 02/03/2014
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Provider Practice Location Address
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Address Line | 1350 WALTON WAY WOUND AND HYPERBARIC
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City | AUGUSTA
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State | GA
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Zip | 30901-2612
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Country | US
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Telephone | 706-774-7242
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Fax | 706-774-7243
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Provider Business Mailing Address
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Address Line | PO BOX 31258 ATTN. CONTRACT PHYSICIAN SERVICES
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City | AUGUSTA
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State | GA
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Zip | 30903-3058
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Country | US
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Telephone | 706-828-2365
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Fax | 706-774-7243
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 015209
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License Number State | GA
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