NPI 1265760482

George Reginald Johnson

Practitioner Contractor Terry, MS

Practice location

Address: 194 Midway Estates Dr, Terry, MS 39170-8488
Phone: (601) 878-0487
Fax: (601) 815-9804
Mailing address: PO Box 1939, Jackson, MS 39215-1939

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X

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Registry record

NPI: 1265760482
Entity type: Individual
Sex (as registered): Male
NPI issued: 29 Nov 2009
Record last updated: 29 Nov 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.