Provider Demographics
NPI:1093078198
Name:JOHNSON, ARCH COURTNEY (DO)
Entity Type:Individual
Prefix:MR
First Name:ARCH
Middle Name:COURTNEY
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 1:130 STONERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9665
Mailing Address - Country:US
Mailing Address - Phone:276-365-6013
Mailing Address - Fax:740-779-8295
Practice Address - Street 1:446 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9030
Practice Address - Country:US
Practice Address - Phone:740-779-8214
Practice Address - Fax:740-779-8295
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY03867207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program