Johnson, Jackie H

Johnson, Jackie H is an individual health care provider with primary practice located at 216 Corder Rd , Warner Robins GA 31088. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Ophthalmology, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Ophthalmology is his primary health care specialty. Johnson, Jackie H can be contacted via phone (478) 923-5872.

Contact Information

Primary practice address
216 Corder Rd Warner Robins GA 31088
Phone: (478) 923-5872
Fax: (478) 929-6266
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X ME114525 Florida
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X 0116022302 Virginia
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 068744 Georgia

Profile Details

NPI number 1679707541
LBN Legal business name Johnson, Jackie H
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 7th, 2009
Last updated May 9th, 2019 - about 7 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679707541 NPPES
Georgia MEDICAID 003134708A

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