Individual
KEVIN FOUNTAIN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1120 15TH ST, BA-1414, AUGUSTA, GA 30912-0004
(706) 721-2076
Mailing address
1120 15TH ST, BA-1414, AUGUSTA, GA 30912-0004
(706) 721-2076
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
LL29904
SC
2085R0202X
Diagnostic Radiology Physician
Primary
61461
GA
Other
Enumeration date
07/18/2007
Last updated
04/05/2013
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