Provider Demographics
NPI:1083804041
Name:JOHNSON, AARON WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:WILLIAM
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 JETT DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-9622
Mailing Address - Country:US
Mailing Address - Phone:606-666-6479
Mailing Address - Fax:606-666-6102
Practice Address - Street 1:540 JETT DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-9622
Practice Address - Country:US
Practice Address - Phone:606-666-6479
Practice Address - Fax:606-666-6102
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201993207R00000X
KY03126207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100070940Medicaid
KY7100070940Medicaid