Individual
JERRY STEVEN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
116 MIMOSA DR, THOMASVILLE, GA 31792-6605
(229) 228-2982
(229) 551-8784
Mailing address
116 MIMOSA DR, THOMASVILLE, GA 31792-6605
(229) 228-2982
(229) 551-8784
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
30487
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00364174A
—
GA
Enumeration date
11/07/2005
Last updated
03/23/2010
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