1437482254 NPI number — TODD E JOHNSON MD PA

Table of content: (NPI 1437482254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437482254 NPI number — TODD E JOHNSON MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TODD E JOHNSON MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LOWCOUNTRY FAMILY MEDICINE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437482254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 HADDINGTON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUFFTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29910-6199
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-757-6597
Provider Business Mailing Address Fax Number:
843-757-6597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 MOSS CREEK VLG
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILTON HEAD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29926-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-441-8727
Provider Business Practice Location Address Fax Number:
843-441-8727
Provider Enumeration Date:
09/11/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
TODD
Authorized Official Middle Name:
ERIC
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
843-757-6597

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  19463 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)