Individual
DR. EDDIE GLEN JOHNSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7330 FERN AVE STE 1103, SHREVEPORT, LA 71105-4989
(318) 798-0635
Mailing address
107 GRAYSON CIR, BOSSIER CITY, LA 71112-8605
(318) 458-2756
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
013312
LA
Other
Enumeration date
11/01/2009
Last updated
11/01/2009
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