Individual
DR. DARYL AUNDRA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 579-5459
(601) 268-5733
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 579-5459
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
23216
MS
207T00000X
Neurological Surgery Physician
T-2057
MS
390200000X
Student in an Organized Health Care Education/Training Program
T-2057
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08681565
—
MS
Enumeration date
10/18/2007
Last updated
08/23/2016
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