Individual
DR. KEITH RUSSELL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
777 HEMLOCK ST, MACON, GA 31201-2102
(478) 331-1000
Mailing address
PO BOX 18824, GREENSBORO, NC 27419-8824
(336) 553-1659
(336) 553-3994
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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