Provider Demographics
NPI:1063455020
Name:JOHNSON, GREGORY JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JAMES
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6740 ROCK SPRING RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3186
Mailing Address - Country:US
Mailing Address - Phone:910-777-8254
Mailing Address - Fax:910-769-1246
Practice Address - Street 1:6740 ROCK SPRING RD STE 100
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405
Practice Address - Country:US
Practice Address - Phone:910-777-8254
Practice Address - Fax:910-769-1246
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00742207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900953Medicaid
NC987816OtherAETNA
140CFOtherBLUECROSS/BLUESHIELD
P00259372OtherRAILROAD MEDICARE
2045047Medicare ID - Type Unspecified
140CFOtherBLUECROSS/BLUESHIELD