1902809692 NPI number — DEBORAH M JOHNSON M.D.

Table of content: DEBORAH M JOHNSON M.D. (NPI 1902809692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902809692 NPI number — DEBORAH M JOHNSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
DEBORAH
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1902809692
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5959 S SHERWOOD FOREST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70816-6038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-765-5727
Provider Business Mailing Address Fax Number:
225-765-9196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4950 ESSEN LN STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70809-3739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-757-0343
Provider Business Practice Location Address Fax Number:
225-757-8354
Provider Enumeration Date:
05/27/2005

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: 207RH0003X , with the licence number:  021976 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1446891 . This is a "MEDICAID GROUP" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1686760 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5CK94 . This is a "MEDICARE GROUP" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 5W980CK94 . This is a "MEDICARE GROUP NUMBER PIN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: P00157711 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: DB9815 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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