Individual
DR. KEITH RUSSELL JOHNSON
Active
Individual
DR. KEITH RUSSELL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
29538
SC
207L00000X
Anesthesiology Physician
Primary
53765
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2500082985
CHAMPUS INDIVIDUAL
GA
05
—
882501185C
—
GA
05
—
882501185E
—
GA
05
—
882501185F
—
GA
05
—
882501185G
—
GA
05
—
882501185H
—
GA
05
—
882501185I
—
GA
05
—
882501185J
—
GA
01
—
P00352150
RR MEDICARE
GA
Enumeration date
08/02/2006
Last updated
11/07/2023
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