Johnson, Daryl Aundra

Johnson, Daryl Aundra is an individual health care provider with primary practice located at 415 S 28Th Ave , Hattiesburg MS 39401-7246. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neurological Surgery, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Neurological Surgery is his primary health care specialty. Johnson, Daryl Aundra can be contacted via phone (601) 579-5459.

Contact Information

Primary practice address
415 S 28Th Ave Hattiesburg MS 39401-7246
Phone: (601) 579-5459
Fax: (601) 268-5733
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurological Surgery 207T00000X T-2057 Mississippi
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X T-2057 Mississippi
Allopathic & Osteopathic Physicians / Neurological Surgery 207T00000X 23216 Mississippi

Profile Details

NPI number 1902095664
LBN Legal business name Johnson, Daryl Aundra
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 18th, 2007
Last updated Aug 23rd, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902095664 NPPES
Mississippi MEDICAID 08681565

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