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Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Adult Medicine |
207QA0505X | 08 | Physician/Family Practice |
| NPI Number | 1962623280 |
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| LBN Legal business name | JOHNSON MEDICAL CLINIC | ||||||||
| Authorized official | CARLA JOHNSON - (OWNER AND SOLE PHYSICIAN) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | No | ||||||||
| Enumeration date | 05/02/2007 | ||||||||
| Last updated | 03/07/2023 - About 3 years ago | ||||||||
| Identifiers |
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JOHNSON MEDICAL CLINIC
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