Individual
GEORGE REGINALD JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
194 MIDWAY ESTATES DR, TERRY, MS 39170-8488
(601) 878-0487
(601) 815-9804
Mailing address
PO BOX 1939, JACKSON, MS 39215-1939
(601) 672-9685
(601) 815-9804
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
11/29/2009
Last updated
11/29/2009
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