Provider Demographics
NPI:1659748333
Name:JOHNSON MEDICAL AND AESTHETICS
Entity Type:Organization
Organization Name:JOHNSON MEDICAL AND AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-580-1516
Mailing Address - Street 1:5500 FREDERICA RD
Mailing Address - Street 2:SUITE 2202
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-9710
Mailing Address - Country:US
Mailing Address - Phone:912-580-1551
Mailing Address - Fax:
Practice Address - Street 1:5500 FREDERICA RD
Practice Address - Street 2:SUITE 2202
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-9710
Practice Address - Country:US
Practice Address - Phone:912-580-1551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA064997208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty