Provider Demographics
NPI:1205939253
Name:JOE E JOHNSON, JR MD APMC
Entity type:Organization
Organization Name:JOE E JOHNSON, JR MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:985-893-9251
Mailing Address - Street 1:PO BOX 1855
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-1855
Mailing Address - Country:US
Mailing Address - Phone:985-893-9251
Mailing Address - Fax:985-892-7893
Practice Address - Street 1:5001 HIGHWAY 190 EAST SERVICE RD
Practice Address - Street 2:SUITE A3
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-4930
Practice Address - Country:US
Practice Address - Phone:985-893-9251
Practice Address - Fax:985-892-7893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1970930Medicaid
LA1970930Medicaid