Individual
CHARLES DAVID JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGACNP
Contact information
Practice address
6051 U S HIGHWAY 49, HATTIESBURG, MS 39401-7200
(601) 288-7000
(601) 450-0518
Mailing address
15 PROFESSIONAL PKWY STE 126, HATTIESBURG, MS 39402-2647
(601) 450-0521
(601) 450-0518
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R875364
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03600303
—
MS
Enumeration date
05/24/2015
Last updated
07/28/2023
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