1831166628 NPI number — DR. ROBERT DUREN JOHNSON JR. MD

Table of content: DR. ROBERT DUREN JOHNSON JR. MD (NPI 1831166628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831166628 NPI number — DR. ROBERT DUREN JOHNSON JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
ROBERT
Provider Middle Name:
DUREN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
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:
1831166628
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2643 GREAT FALLS HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29720-7168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-286-1586
Provider Business Mailing Address Fax Number:
803-313-3283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
672 HIGHWAY 9 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENNETTSVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29512-2130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-479-2402
Provider Business Practice Location Address Fax Number:
843-479-6609
Provider Enumeration Date:
03/01/2006

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: 207ZP0102X , with the licence number:  8389 , 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: 083894 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4469 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 30048 . This is a "NC STATE LICENSE NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0120X . This is a "NC BCBS GROUP NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8389 . This is a "SC MEDICAL LICENSE NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP0789 . This is a "SC MEDICAID GROUP NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com