Provider Demographics
NPI:1043247117
Name:JOHNSON, STEVEN G (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:G
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 GLYNCO PKWY
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-7921
Mailing Address - Country:US
Mailing Address - Phone:912-264-9111
Mailing Address - Fax:912-262-6909
Practice Address - Street 1:1111 GLYNCO PKWY
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-7921
Practice Address - Country:US
Practice Address - Phone:912-264-9111
Practice Address - Fax:912-262-6909
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME9412174400000X
GA017836207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine