Organization
SOUTHERN ORTHOPAEDICS AND SPORTS MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALD L JOHNSON MHA/MBA/ PH.D. (PRACTICE ADMINISTRATIVE OFFICER)
(912) 265-9006
Entity
Organization
Contact information
Practice address
3231 GLYNN AVE, BRUNSWICK, GA 31520-4851
(912) 265-9006
Mailing address
3231 GLYNN AVE, BRUNSWICK, GA 31520-4851
(912) 265-9006
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT011539
GA
Other
Enumeration date
09/18/2014
Last updated
09/18/2014
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