Individual
BRANDON JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
2429 5TH ST N, COLUMBUS, MS 39705-2005
(662) 328-4542
Mailing address
2429 5TH ST N, COLUMBUS, MS 39705-2005
(662) 328-4542
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0305
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110202022
ATHLETIC TRAINER LICENSE NUMBER
—
Enumeration date
01/12/2021
Last updated
04/06/2021
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