Provider Demographics
NPI:1760430177
Name:JOHNSON, WILLIAM R (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 BATTLEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:FT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-3945
Mailing Address - Country:US
Mailing Address - Phone:706-866-7575
Mailing Address - Fax:
Practice Address - Street 1:955 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3945
Practice Address - Country:US
Practice Address - Phone:706-866-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1488111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU21415Medicare UPIN
GA35ZCHPQMedicare PIN