Johnson, Samuel O

Johnson, Samuel O is an individual health care provider with primary practice located at 109 Ambulance Drive , Carrollton GA 30117-3855. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gynecology, which is considered as his primary health care specialty. Johnson, Samuel O can be contacted via phone (770) 214-1335.

Contact Information

Primary practice address
109 Ambulance Drive Carrollton GA 30117-3855
Phone: (770) 214-1335
Fax: (770) 214-1332
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gynecology 207VG0400X 026137 Georgia

Profile Details

NPI number 1457394165
LBN Legal business name Johnson, Samuel O
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2006
Last updated Mar 27th, 2009 - about 17 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 1457394165 NPPES
Georgia Other 52486217003 BLUE CROSS
Georgia MEDICAID 000531319O BLUE CROSS

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