Provider Demographics
NPI:1093959553
Name:JOHNSON, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
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 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-2200
Mailing Address - Fax:216-445-6148
Practice Address - Street 1:1348 WALTON WAY STE 5100
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-5108
Practice Address - Country:US
Practice Address - Phone:706-724-8611
Practice Address - Fax:706-724-6202
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.127754207RC0000X
OH57.022380207RC0000X
VA0101253138207R00000X
GA79999207RC0000X
390200000X
GA7999207RI0011X
GA079999207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology