Individual
JODY MICHAEL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5000 KY ROUTE 321, SUITE 3141, PRESTONSBURG, KY 41653
(606) 889-6240
(606) 886-9908
Mailing address
PO BOX 1239, PRESTONSBURG, KY 41653-5239
(606) 889-6240
(606) 886-9908
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
02979
KY
208600000X
Surgery Physician
Primary
02979
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64121213
—
KY
Enumeration date
06/29/2006
Last updated
02/03/2021
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