1124289681 NPI number — WILLIAM RUFFIN JOHNSON OTRL CHT

Table of content: WILLIAM RUFFIN JOHNSON OTRL CHT (NPI 1124289681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124289681 NPI number — WILLIAM RUFFIN JOHNSON OTRL CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
WILLIAM
Provider Middle Name:
RUFFIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTRL CHT
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:
1124289681
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 MCDOWELL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28801-4104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-253-7521
Provider Business Mailing Address Fax Number:
828-251-5992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 S FRENCH BROAD AVE
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28801-3282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-350-0800
Provider Business Practice Location Address Fax Number:
828-350-0801
Provider Enumeration Date:
06/18/2008

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: 225XH1200X , with the licence number:  0384 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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