Individual
MR. MITCHELL LAMAR JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10176 WELDWOOD DR, MERIDIAN, MS 39307-9368
(160) 155-9018
Mailing address
PO BOX 3250, MERIDIAN, MS 39303-3250
(601) 559-0185
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
800098410
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
800098410
DRIVER LICENSE
MS
Enumeration date
01/26/2021
Last updated
01/26/2021
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