Individual
TERRANCE A JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1128 HIGHLAND PARKWAY, SUITE 200, PICAYUNE, MS 39466-9197
(601) 358-9630
(601) 358-9640
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 358-9630
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18444
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03310041
—
MS
05
—
1425567
—
LA
01
—
3470981
AMERICAN ADMIN GROUP
MS
Enumeration date
08/18/2006
Last updated
07/22/2020
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