1184615437 NPI number — DR. DONALD R JOHNSON II M.D.

Table of content: DR. DONALD R JOHNSON II M.D. (NPI 1184615437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184615437 NPI number — DR. DONALD R JOHNSON II M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
DONALD
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
II
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1184615437
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
217 DOZIER BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29501-4090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-669-5162
Provider Business Mailing Address Fax Number:
843-667-4573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1106 CHUCK DAWLEY BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29464-4183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-849-1551
Provider Business Practice Location Address Fax Number:
843-849-6591
Provider Enumeration Date:
11/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XS0117X , with the licence number:  12300 , 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)

  • Identifier: P00000850 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 123002 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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