Provider Demographics
NPI:1255488144
Name:JOHNSON, JEFFERY CHAD (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:CHAD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9086
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-9086
Mailing Address - Country:US
Mailing Address - Phone:706-596-4170
Mailing Address - Fax:706-322-8483
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:STE 1007
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6877
Practice Address - Country:US
Practice Address - Phone:706-596-4170
Practice Address - Fax:706-322-8483
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255770208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)