Individual
DR. SAMUEL A JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 LEIGH DR, COLUMBUS, MS 39705-3014
(662) 327-7525
(662) 243-2252
Mailing address
600 LEIGH DR, COLUMBUS, MS 39705-3014
(662) 327-7525
(662) 243-2252
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
13781
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00114403
—
MS
01
—
009914955
ALACAID
MS
01
—
100015721
RAILROAD MEDICARE
MS
01
—
640813832
TAX ID
MS
01
—
730-06661
BLUE CROSS OF ALABAMA
MS
Enumeration date
07/27/2006
Last updated
01/10/2012
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