Individual
KEVIN R. JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2402 5TH ST N, COLUMBUS, MS 39705-2000
(662) 690-8007
(662) 842-4653
Mailing address
PO BOX 405827, ATLANTA, GA 30384-5827
(870) 934-5821
(870) 934-5384
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18376
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06202721
—
MS
Enumeration date
03/09/2006
Last updated
06/10/2011
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