Marc E Johnson (NPI# 1730475815, PAC ID# 5698098069) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1730475815 |
| PAC ID by PECOS | 5698098069 |
| Professional Enrollment ID | I20150922000665 |
| Full Name | Marc E Johnson |
| Organization Legal Name | KDMC PHYSICIAN CLINICS LLC |
| Address |
1014 D A Biglane Dr Brookhaven MS 39601-2331 |
| Phone Number | 6018235275 |
| Gender | M |
| Medical School | MEHARRY MEDICAL COLLEGE SCHOOL OF MEDICINE |
| Graduation Year | 2012 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 7012154495 |
| Number of Group Practice Members | 20 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 250057 | KING'S DAUGHTERS MEDICAL CENTER-BROOKHAVEN |
| Address | Phone | Organization |
|---|---|---|
| 1014 D A Biglane Dr, Brookhaven, MS 39601-2331 | 6018235275 | KDMC PHYSICIAN CLINICS LLC |
| 940 Brookway Blvd, Brookhaven, MS 39601-2644 | 6018235000 | KDMC PHYSICIAN CLINICS LLC |
| 950 Brookway Blvd, Brookhaven, MS 39601-2644 | 6018337973 | KDMC PHYSICIAN CLINICS LLC |
| Organization Legal Name | KDMC PHYSICIAN CLINICS LLC |
| Physicians | 21 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Katherine Ross Flynn | Nurse Practitioner | Kdmc Physician Clinics LLC | 509 Brookman Dr, Brookhaven, MS 39601-2326 |
| Mark Timothy Barron | Orthopedic Surgery | Kdmc Physician Clinics LLC | 1014 D A Biglane Dr, Brookhaven, MS 39601-2331 |
| Ramiro A. Montalvo Jr. | Internal Medicine | Kdmc Physician Clinics LLC | 940 Brookway Blvd, Brookhaven, MS 39601-2644 |
| John D Richardson | Psychiatry | Kdmc Physician Clinics LLC | 601 Brookman Dr Ext A, Brookhaven Sports Med and Orthop, Brookhaven, MS 39601-2371 |
| Charles M Holland | Pediatric Medicine | Kdmc Physician Clinics LLC | 950 Brookway Blvd, Brookhaven, MS 39601-2644 |
| Blaine C Britt | Internal Medicine | Kdmc Physician Clinics LLC | 940 Brookway Blvd, Brookhaven, MS 39601-2644 |
| Daniel Craig Moore | Nurse Practitioner | Kdmc Physician Clinics LLC | 940 Brookway Blvd, Brookhaven, MS 39601-2644 |
| John E Turba | Orthopedic Surgery | Kdmc Physician Clinics LLC | 1014 D A Biglane Dr, Brookhaven, MS 39601-2331 |
| Catherine W Knott | Nurse Practitioner | Kdmc Physician Clinics LLC | 940 Brookway Blvd, Brookhaven, MS 39601-2644 |
| Dena W Jackson | Internal Medicine | Kdmc Physician Clinics LLC | 940 Brookway Blvd, Brookhaven, MS 39601-2644 |
| Street Address |
1014 D A BIGLANE DR |
| City | BROOKHAVEN |
| State | MS |
| Zip | 39601-2331 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Mark Timothy Barron | Orthopedic Surgery | Kdmc Physician Clinics LLC | 1014 D A Biglane Dr, Brookhaven, MS 39601-2331 |
| John E Turba | Orthopedic Surgery | Kdmc Physician Clinics LLC | 1014 D A Biglane Dr, Brookhaven, MS 39601-2331 |
| Bradley J Martin | Physician Assistant | Kdmc Physician Clinics LLC | 1014 D A Biglane Dr, Brookhaven, MS 39601-2331 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Michael A Stewart | General Surgery | 747 Industrial Park Rd Ne, Brookhaven, MS 39601-2065 | |
| James B Hall | Nephrology | 747 Industrial Park Rd Ne, Brookhaven, MS 39601-2065 | |
| Jani L Purvis | Diagnostic Radiology | 108 Lance Alworth Dr, Brookhaven, MS 39601-2300 | |
| Katherine Ross Flynn | Nurse Practitioner | Kdmc Physician Clinics LLC | 509 Brookman Dr, Brookhaven, MS 39601-2326 |
| Richard E. Miller | Nephrology | Southwest Ms Nephrology, Pllc | 513 C Brookman Dr, Brookhaven, MS 39601-2326 |
| Holly Alicia Kimbrell | Nurse Practitioner | Southwest Ms Nephrology, Pllc | 513 C Brookman Dr, Brookhaven, MS 39601-2326 |
| Braxter P Irby Jr. | Internal Medicine | Southwest Ms Nephrology, Pllc | 513 C Brookman Dr, Brookhaven, MS 39601-2326 |
| Timothy R Shann | Pediatric Medicine | Kdmc Physician Clinics LLC | 509 Brookman Dr, Brookhaven, MS 39601-2326 |
| Charles Asa Reynolds | General Surgery | Brookhaven Surgery Clinic P.a. | 1036 D A Biglane Dr, Brookhaven, MS 39601-2331 |
| Briana Hall Price | Nurse Practitioner | Brookhaven Anesthesia and Pain Management | 1024 D A Biglane Dr, Brookhaven, MS 39601-2331 |
| Find all physicians in zip 39601 | |||
| City | BROOKHAVEN |
| Zip Code | 39601 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | BROOKHAVEN + FAMILY MEDICINE |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.