Individual
KENNETH ALLAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1601 FAIR RD, SUITE 300, STATESBORO, GA 30458-1698
(912) 871-6742
(912) 871-2563
Mailing address
127 OAK RIDGE DR, STATESBORO, GA 30458-9135
(912) 871-6742
(912) 871-2563
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
037577
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00572041A
—
GA
Enumeration date
08/10/2005
Last updated
07/07/2014
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