Individual
THOMAS DWAYNE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1417 N MAIN ST, JAMESTOWN, KY 42629-2411
(270) 343-2597
(270) 343-2598
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
37317
KY
208D00000X
General Practice Physician
37317
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000294096
ANTHEM BC/BS
KY
Enumeration date
07/08/2005
Last updated
01/10/2023
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