Provider Demographics
NPI:1326082033
Name:JOHNSON, JOE H (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:H
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 1:2409 N PATTERSON ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2512
Mailing Address - Country:US
Mailing Address - Phone:229-259-4369
Mailing Address - Fax:229-433-6513
Practice Address - Street 1:2409 N PATTERSON ST
Practice Address - Street 2:SUITE 230
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2512
Practice Address - Country:US
Practice Address - Phone:229-259-4369
Practice Address - Fax:229-433-6513
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025621208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2501248OtherBLUE CROSS HMO
GA00391058FMedicaid
GA770002553OtherRAILROAD
GA5569443OtherBLUE CROSS PPO
GA00391058FMedicaid
GAE19617Medicare UPIN