| William R. Johnson, Ph.d., Pc | |
|
1421 Lee St Brunswick GA 31520-7132 | |
| (912) 265-0007 | |
| (912) 261-0593 |
| Full Name | William R. Johnson, Ph.d., Pc |
|---|---|
| Speciality | Psychologist |
| Location | 1421 Lee St, Brunswick, Georgia |
| Authorized Official Name and Position | William R Johnson (PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 9122650007 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| William R. Johnson, Ph.d., Pc 1421 Lee St Brunswick GA 31520-7132 Ph: (912) 265-0007 | William R. Johnson, Ph.d., Pc 1421 Lee St Brunswick GA 31520-7132 Ph: (912) 265-0007 |
| NPI Number | 1407019771 |
|---|---|
| Provider Enumeration Date | 07/08/2008 |
| Last Update Date | 07/08/2008 |
| Medicare PECOS PAC ID | 7911067962 |
|---|---|
| Medicare Enrollment ID | O20081120000231 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407019771 | NPI | - | NPPES |
| 00183356C | Medicaid | GA | |
| 10044538 | Other | AMERIGROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PSY000541 (Georgia) | Primary |
| Provider Name | William R Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760577092 PECOS PAC ID: 9032279518 Enrollment ID: I20081114000212 |
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