Individual
DR. THEODORE SAMUEL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
1120 FIFTEENTH STREET, CN-4141A, AUGUSTA, GA 30912
(706) 721-3626
(706) 721-4804
Mailing address
1120 FIFTEENTH STREET, CN-4141A, AUGUSTA, GA 30912
(706) 721-3626
(706) 721-4804
Taxonomy
Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
64115
GA
Other
Enumeration date
04/04/2007
Last updated
06/15/2017
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