DR. DURWOOD M JOHNSON JR. (NPI# 1861505141) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861505141 |
| Entity Type | Individual |
| Full Name | DR. DURWOOD M JOHNSON JR. |
| Credential | DMD |
| Practice Address |
1260 Hwy 54 W Suite 200 Fayetteville GA 30214 |
| Practice Telephone | 7704612101 |
| Practice Fax Number | 7704601292 |
| Mailing Telephone | 7704612101 |
| Mailing Fax Number | 7704601292 |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2012-06-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 204E00000X | Oral & Maxillofacial Surgery | 7973 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000189351B | 05 |
| Street Address |
1260 HWY 54 W SUITE 200 |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
| 1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
| 1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
| 1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
| Find all providers in zip 30214 | ||||
| Taxonomy Code | 204E00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Oral & Maxillofacial Surgery |
| Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. |
| Notes: Source: American College of Surgeons, 2013. www.facs.org [7/1/2013: definition added, source added, additional resources added] Additional Resources: American Board of Oral and Maxillofacial Surgery and American Association of Oral and Maxillofacial Surgeons While this is generally considered a specialty of dentistry, physicians can also be board certified as oral and maxillofacial surgeons through the American Board of Oral and Maxillofacial Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932519485 | Premier Anesthesia of Arkansas Professional Corporation | Oral & Maxillofacial Surgery | 3215 N Northhills Blvd, Fayetteville, AR 72703-4424 | 2014-05-06 |
| 1396094074 | Oral An Implant Surgery Specialists, PC | Oral & Maxillofacial Surgery | 1260 Highway 54 W, Suite 200, Fayetteville, GA 30214-4514 | 2012-09-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124453337 | Ladi Doonquah | Oral & Maxillofacial Surgery | 3660 Flat Shoals Rd Ste 100, Decatur, GA 30034-1649 | 2013-09-06 |
| 1699040121 | Shenan Marie Bradshaw | Oral & Maxillofacial Surgery | 5505 Peachtree Dunwoody Rd Ste 660, Sandy Springs, GA 30342 | 2012-03-16 |
| 1720107105 | Christian Loetscher | Oral & Maxillofacial Surgery | 4205 N Point Pkwy Ste F, Alpharetta, GA 30022-8808 | 2007-03-28 |
| 1659460772 | William Jones Phillips | Oral & Maxillofacial Surgery | 698 Medical Park Lane, Gainesville, GA 30501 | 2006-10-12 |
| 1841306909 | Lawrence Matthew Marra | Oral & Maxillofacial Surgery | 3965 Holcomb Bridge Road, Suite 102, Norcross, GA 30092 | 2006-08-22 |
| 1184667370 | Scott S Derossi | Oral & Maxillofacial Surgery | 1430 John Wesley Gilbert Drive, Gc-1024, Ghsu College of Dental Medicine, Augusta, GA 30912-1001 | 2006-06-14 |
| 1942258397 | Henry W Ferguson | Oral & Maxillofacial Surgery | 1430 John Wesely Gilbert Drive, Gc-1024, Augusta, GA 30912-1001 | 2006-05-05 |
| 1295791549 | Glenn Maron | Oral & Maxillofacial Surgery | 999 Peachtree St Ne, Ste 715, Atlanta, GA 30309 | 2006-04-25 |
| 1952363442 | Advanced Oral and Maxillofacial Surgery PC | Oral & Maxillofacial Surgery | 3535 Roswell Rd, Suite 27, Marietta, GA 30062-8826 | 2006-04-03 |
| 1114425964 | Gofs Stockbridge | Oral & Maxillofacial Surgery | 225 Country Club Dr, #110, Stockbridge, GA 30281 | 2018-01-26 |
| Find all providers with the same taxonomy | ||||
| City | FAYETTEVILLE |
| Zip Code | 30214 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.