Johnson, Daryl Aundra
Johnson, Daryl Aundra is an individual health care provider with primary practice located at 415 S 28Th Ave , Hattiesburg MS 39401-7246. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neurological Surgery, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Neurological Surgery is his primary health care specialty. Johnson, Daryl Aundra can be contacted via phone (601) 579-5459.Contact Information
Primary practice address
415 S 28Th Ave
Hattiesburg MS 39401-7246
Phone: (601) 579-5459
Fax: (601) 268-5733
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neurological Surgery | 207T00000X | T-2057 | Mississippi |
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | T-2057 | Mississippi |
| Allopathic & Osteopathic Physicians / Neurological Surgery | 207T00000X | 23216 | Mississippi |
Profile Details
| NPI number | 1902095664 |
|---|---|
| LBN Legal business name | Johnson, Daryl Aundra |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 18th, 2007 |
| Last updated | Aug 23rd, 2016 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902095664 | NPPES |
| Mississippi | MEDICAID | 08681565 |
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