1235177114 NPI number — TONICA VINETTA JOHNSON MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235177114 NPI number — TONICA VINETTA JOHNSON MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

JOHNSON

Provider First Name:

TONICA

Provider Middle Name:

VINETTA

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

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:

1235177114

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/21/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1821 HILLANDALE RD 1B #300

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

DURHAM

Provider Business Mailing Address State Name:

NC

Provider Business Mailing Address Postal Code:

27706

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

216-509-1814

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1821 HILLANDALE RD 1B #300

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

DURHAM

Provider Business Practice Location Address State Name:

NC

Provider Business Practice Location Address Postal Code:

27706

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

216-509-1814

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

06/03/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207W00000X , with the licence number:  A87493 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207W00000X , with the licence number: 200600411 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 808293 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 0800905 . This is a "UHC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: P00340942 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
• Identifier: 142VK . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 5904044 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 188041 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 808293 . This is a "COMMUNITY EYE CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 0800905 . This is a "MAMSI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 1326265 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 33400 . This is a "OPTICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: OPH182 . This is a "PRIMAHEALTH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".