Individual
DANNETTE SMITH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2500 NORTH STATE STREET, DEPARTMENT OF MEDICINE DIVISION OF RHEUMATOLOGY, JACKSON, MS 39216-4500
(601) 984-5540
Mailing address
2500 NORTH STATE STREET, JMM ROOM 2525, JACKSON, MS 39216-4500
(601) 984-6426
(601) 984-6439
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
19808
MS
207RR0500X
Rheumatology Physician
L9266
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06807377
—
MS
05
—
1029297
—
LA
05
—
106542
—
AL
01
—
P01234022
RAILROAD MEDICARE
MS
Enumeration date
01/10/2007
Last updated
12/30/2015
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