Provider Demographics
NPI:1295756757
Name:JOHNSON, WILLIAM P JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:POTTER
Other - Last Name:JOHNSON
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:108 ISLAND PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-2880
Mailing Address - Country:US
Mailing Address - Phone:912-268-4372
Mailing Address - Fax:
Practice Address - Street 1:108 ISLAND PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-2880
Practice Address - Country:US
Practice Address - Phone:912-268-4372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32549207P00000X
KYR0961207P00000X
GA064997207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYR0961OtherLICENSE
IN01063853AOtherINDIANA STATE LICENSE
KYBJ9323508OtherDEA LICENSE