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Individual

DR. SAMUEL O JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
109 AMBULANCE DRIVE, CARROLLTON, GA 30117-3855
(770) 214-1335
(770) 214-1332
Mailing address
109 AMBULANCE DRIVE, CARROLLTON, GA 30117-3855
(770) 214-1335
(770) 214-1332

Taxonomy

Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
026137
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000531319O
GA
01
52486217003
BLUE CROSS
GA
Enumeration date
06/13/2006
Last updated
03/27/2009
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