Provider Demographics
NPI:1619985819
Name:JOHNSON, WILLIAM S III (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
Last Name:JOHNSON
Suffix:III
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 1:502 RUE DE SANTE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-5424
Mailing Address - Country:US
Mailing Address - Phone:985-653-5570
Mailing Address - Fax:985-653-5575
Practice Address - Street 1:502 RUE DE SANTE
Practice Address - Street 2:SUITE 106
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-5424
Practice Address - Country:US
Practice Address - Phone:985-653-5570
Practice Address - Fax:985-653-5575
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL019071207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Not Answered207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
82565OtherCOVENTRY
200045514OtherRAILROAD MEDICARE
173972500OtherUS DEPT OF LABOR
LA1958999Medicaid
8710244002OtherCIGNA
4513032OtherAETNA
0900158OtherUNITED HEALTHCARE