Individual
AMANDA BETH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
140 BURKE CALHOUN CITY RD, CALHOUN CITY, MS 38916-9690
(662) 628-6622
Mailing address
620 CROSSOVER RD, TUPELO, MS 38801-4944
(850) 873-3990
(850) 215-0469
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
26427
MS
2085R0202X
Diagnostic Radiology Physician
OS15269
FL
2085R0204X
Vascular & Interventional Radiology Physician
Primary
26427
MS
2085R0204X
Vascular & Interventional Radiology Physician
OS15269
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04385321
—
MS
01
—
FY7AZ
FL BLUE PROVIDER NUMBER
FL
Enumeration date
06/30/2010
Last updated
12/05/2023
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