Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1488 | GA |
NPI | 1760430177 |
---|---|
Provider Name | William R Johnson |
First Address | Ft Oglethorpe, GA 30742-3945 |
Second Address | Ft Oglethorpe, GA 30742-3945 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 01/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U21415 | (02) | GA |