Organization
SOUTHEAST ENT & FACIAL PLASTIC SURGEYR, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT E JOHNSON M.D. (OWNER)
(912) 330-5030
Entity
Organization
Contact information
Practice address
1000 TOWNE CENTER BLVD, SUITE 501, POOLER, GA 31322-4052
(912) 330-5030
(912) 330-5033
Mailing address
1000 TOWNE CENTER BLVD, SUITE 501, POOLER, GA 31322-4052
(912) 330-5030
(912) 330-5033
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
035071
GA
Other
Enumeration date
09/01/2011
Last updated
09/01/2011
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