Provider Demographics
NPI:1073653945
Name:JOHNSON, EMILY KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:KATHLEEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4216
Mailing Address - Country:US
Mailing Address - Phone:502-235-3114
Mailing Address - Fax:
Practice Address - Street 1:2016 1ST AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-0408
Practice Address - Country:US
Practice Address - Phone:843-873-4545
Practice Address - Fax:843-873-1561
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38009208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics