Individual
JOHNNY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4211 JOE RAMSEY BLVD, SUITE 100, GREENVILLE, TX 75401
(903) 408-5838
(903) 408-5839
Mailing address
4211 JOE RAMSEY BLVD, SUITE 100, GREENVILLE, TX 75401
(903) 408-7700
(903) 408-7802
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00777
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45-3870
MEDICARE RHC NUMBER
TX
Enumeration date
10/14/2009
Last updated
06/08/2018
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