Individual
DR. WILLIAM WALTER JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1935 LAKELAND DR STE 900, JACKSON, MS 39216-5028
(601) 840-1454
Mailing address
536 ROYAL PECAN WAY, COLLIERVILLE, TN 38017-1734
(662) 538-8009
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
14886
MS
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
Primary
14886
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00117218
—
MS
05
—
09015923
—
MS
01
—
743030196
PRACTICE TAX ID #
MS
Enumeration date
06/08/2005
Last updated
07/28/2021
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