Individual
DR. EDDIE PRINCE JOHNSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
27 5 5 BARTON CHAPEL ROAD, AUGUSTA, GA 30906-9579
(706) 790-9179
Mailing address
3400 HEATHER DR, AUGUSTA, GA 30909-2795
(707) 736-5421
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9685
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00254526C
—
GA
Enumeration date
03/26/2007
Last updated
11/10/2011
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