George Reginald Johnson
Individual provider Active NPI Contractor · Terry, MS
NPI 1265760482 · NPPES record last updated Nov 29, 2009
Key facts
- NPI
- 1265760482
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 194 Midway Estates Dr
Terry, MS 39170-8488 - Phone
- (601) 878-0487
- Fax
- (601) 815-9804
- NPI assigned
- Nov 29, 2009
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | Yes |
Addresses
Primary practice location
194 Midway Estates Dr
Terry, MS 39170-8488
Mailing address
PO Box 1939
Jackson, MS 39215-1939
Phone (601) 672-9685
Other providers in Terry, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.