Provider Demographics
NPI:1821180514
Name:JOHNSON, JAMES C JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:499 GLOSTER CREEK VLG STE A2
Mailing Address - Street 2:CARDIOLOGY ASSOCIATES OF NORTH MS
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4749
Mailing Address - Country:US
Mailing Address - Phone:662-620-6800
Mailing Address - Fax:662-662-6920
Practice Address - Street 1:499 GLOSTER CREEK VLG STE A2
Practice Address - Street 2:CARDIOLOGY ASSOCIATES OF NORTH MS
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4749
Practice Address - Country:US
Practice Address - Phone:662-620-6800
Practice Address - Fax:662-662-6920
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS14408207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0121596Medicaid
H08995Medicare UPIN
MS060000464Medicare ID - Type Unspecified