Individual
DR. JACKIE H JOHNSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
216 CORDER RD, WARNER ROBINS, GA 31088
(478) 923-5872
(478) 929-6266
Mailing address
PO BOX 6479, WARNER ROBINS, GA 31095
(478) 923-5872
(478) 929-6266
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
068744
GA
207W00000X
Ophthalmology Physician
ME114525
FL
390200000X
Student in an Organized Health Care Education/Training Program
0116022302
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003134708A
—
GA
Enumeration date
05/07/2009
Last updated
05/09/2019
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