Individual
SAMMY VAUN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGACNP
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-9617
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
902237
MS
Other
Enumeration date
09/19/2017
Last updated
09/19/2017
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