MEDICARE: DR. JOE H 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
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	025621	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2501248	OTHER	GA	BLUE CROSS HMO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	770002553	OTHER	GA	RAILROAD
4	5569443	OTHER	GA	BLUE CROSS PPO
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326082033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOE H JOHNSON M.D.

Provider Business Mailing Address
First Line	:	2409 N PATTERSON ST
Second Line	:	SUITE 230
City	:	VALDOSTA
State	:	GA
Zip	:	31602-2512
Country	:	US
Telephone Number	:	229-259-4369
Fax Number	:	229-433-6513

Provider Business Practice Location Address
First Line	:	2409 N PATTERSON ST
Second Line	:	SUITE 230
City	:	VALDOSTA
State	:	GA
Zip	:	31602-2512
Country	:	US
Telephone Number	:	229-259-4369
Fax Number	:	229-433-6513

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	09/09/2014

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Directions to “ DR. JOE H JOHNSON M.D.” Practice Location

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