Individual
MATHEW BOWEN JOHNSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
703 ALCORN DR, SUITE 102, CORINTH, MS 38834-9302
(662) 286-2522
(662) 293-4288
Mailing address
703 ALCORN DR, SUITE 102, CORINTH, MS 38834-9302
(662) 286-2522
(662) 293-4288
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
15536
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00122266
—
MS
Enumeration date
07/26/2006
Last updated
05/14/2021
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