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NPI Code Detail

MEDICARE: DR. SAMANTHA JO JOHNSON M.D.

MEDICARE: DR. SAMANTHA JO JOHNSON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology PhysicianME138885FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
122641OTHERFLFLORIDA STATE MEDICAL LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154778413
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SAMANTHA JO JOHNSON M.D.
Provider Business Mailing Address
First Line : 4205 BELFORT RD STE 4015
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-3623
Country : US
Telephone Number : 904-450-6063
Fax Number : 904-539-4091
Provider Business Practice Location Address
First Line : 2156 W NINE MILE RD
Second Line :
City : PENSACOLA
State : FL
Zip : 32534-9464
Country : US
Telephone Number : 850-416-2433
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2016
Last Update Date : 12/12/2022

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