Organization
SIDNEY P JOHNSON, M.D. P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PHYLLIS GRIFFIN (INSURANCE MANAGER)
(912) 375-2521
Entity
Organization
Contact information
Practice address
11 JOHNSON ST, HAZLEHURST, GA 31539-6243
(912) 375-2521
Mailing address
PO BOX 787, HAZLEHURST, GA 31539-0787
(912) 375-2521
(912) 375-2409
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
10971
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00112912A
—
GA
Enumeration date
10/23/2007
Last updated
10/23/2007
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