Individual
MR. DAVID SHANE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
376A SIMPSON HIGHWAY 149, MAGEE, MS 39111-3409
(601) 849-1475
(601) 849-1549
Mailing address
PO BOX 769, MAGEE, MS 39111-0769
(601) 849-1475
(601) 849-1549
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA024
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00125918
—
MS
Enumeration date
05/17/2007
Last updated
12/23/2019
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