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General NPI Number Information
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NPI Number | 1992773535
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Entity Type | Individual
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Provider Name | KEVIN R. JOHNSON DO
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Gender | Male
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 06/10/2011
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Provider Practice Location Address
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Address Line | 2402 5TH ST N
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City | COLUMBUS
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State | MS
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Zip | 39705-2000
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Country | US
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Telephone | 662-690-8007
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Fax | 662-842-4653
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Provider Business Mailing Address
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Address Line | PO BOX 405827
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City | ATLANTA
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State | GA
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Zip | 30384-5827
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Country | US
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Telephone | 870-934-5821
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Fax | 870-934-5384
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 18376
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License Number State | MS
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