Individual
WILLIAM P JOHNSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
108 ISLAND PROFESSIONAL PARK, ST SIMONS ISLAND, GA 31522-2880
(912) 268-4372
Mailing address
108 ISLAND PROFESSIONAL PARK, ST SIMONS ISLAND, GA 31522-2880
(912) 268-4372
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
32549
SC
207P00000X
Emergency Medicine Physician
R0961
KY
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
064997
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01063853A
INDIANA STATE LICENSE
IN
01
—
R0961
LICENSE
KY
Enumeration date
07/21/2006
Last updated
05/01/2024
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