Individual
DR. SAMUEL TERRY JOHNSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
629 NUCKOLLS RD, BOLIVAR, TN 38008-1599
(731) 658-3388
(731) 658-4079
Mailing address
PO BOX 720, BOLIVAR, TN 38008-0720
(731) 659-3125
(731) 659-3131
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
47830
TN
Other
Enumeration date
02/02/2009
Last updated
12/14/2011
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