Individual
MR. CARL DAVID JOHNSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
612 LOVE AVE, TIFTON, GA 31794
(229) 391-3300
(229) 388-1948
Mailing address
612 LOVE AVE, TIFTON, GA 31794
(229) 391-3300
(229) 388-1948
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
28796
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000375251E
—
GA
Enumeration date
07/27/2005
Last updated
05/08/2015
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