Provider Demographics
NPI:1619906179
Name:FRANKLIN, JOHNNY B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:B
Last Name:FRANKLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHNNY
Other - Middle Name:B
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-1810
Mailing Address - Country:US
Mailing Address - Phone:228-865-1453
Mailing Address - Fax:228-865-1451
Practice Address - Street 1:1110 BROAD AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-8907
Practice Address - Country:US
Practice Address - Phone:228-385-4645
Practice Address - Fax:228-385-4695
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09110207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00112514Medicaid
MS010045609OtherRAILROAD MEDICARE
MS00112514Medicaid
MS010045609OtherRAILROAD MEDICARE
MSD00919Medicare UPIN
MS110000608Medicare ID - Type Unspecified
MS$$$$$$$$$EOtherBCBS
MS302I115951Medicare PIN