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Contact Information

JACKIE H JOHNSON JR, MD
216 CORDER RD
WARNER ROBINS, GA31088
 Phone: 478-923-5872
 Fax: 478-929-6266
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Ophthalmology

207W00000X 18 Physician/Ophthalmology
 

Student in an Organized Health Care Education/Training Program

390200000X
Indicates primary specialty

NPI Profile & details for JACKIE H JOHNSON JR · (Male)

NPI Number 1679707541
Status Active
Credentials MD
Entity Individual
Enumeration date 05/07/2009
Last updated 05/09/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • FL License # ME114525
  • GA License # 068744
  • VA License # 0116022302
  • GA Medicaid 003134708A
Hospital affiliation(s)
  • BACON COUNTY HOSPITAL - (Critical Access)
    302 SOUTH WAYNE STREET
    ALMA, GA 31510
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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