Individual
MR. C EMORY JOHNSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3708 NORTHSIDE DR, MACON, GA 31210-2404
(478) 745-4206
(478) 254-5463
Mailing address
PO BOX 6317, MACON, GA 31208
(478) 745-4206
(478) 254-5463
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
01196511
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00077239A
—
GA
01
—
200018430
MEDICARE RAILROAD
GA
Enumeration date
11/08/2006
Last updated
06/01/2011
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