Provider Demographics
NPI:1093778490
Name:JOHNSON, WILLIAM ARNOLD SR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ARNOLD
Last Name:JOHNSON
Suffix:SR
Gender:M
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:PO BOX 60371
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0371
Mailing Address - Country:US
Mailing Address - Phone:803-779-3070
Mailing Address - Fax:803-771-7639
Practice Address - Street 1:1920 PICKENS ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:803-779-3070
Practice Address - Fax:803-771-7639
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6727207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC067279Medicaid
SCD092621357Medicare PIN
D09262Medicare UPIN