Individual
DR. EVELYN DELOIS JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1600 GLOUCESTER ST, BRUNSWICK, GA 31520-7145
(912) 265-8080
(912) 265-8513
Mailing address
1600 GLOUCESTER ST, BRUNSWICK, GA 31520-7145
(912) 265-8080
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
039602
GA
208000000X
Pediatrics Physician
ME 60541
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00636028B
—
GA
Enumeration date
01/05/2007
Last updated
06/09/2008
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