Provider Demographics
NPI:1164551198
Name:JOHNSON, ALISON JOAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:JOAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:JOAN
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5960 FAIRVIEW RD STE 500
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3113
Mailing Address - Country:US
Mailing Address - Phone:704-495-6334
Mailing Address - Fax:
Practice Address - Street 1:9615 KINCEY AVE STE 210
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-9140
Practice Address - Country:US
Practice Address - Phone:704-900-6225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01199207RR0500X
NC127107207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1164551198Medicaid
SCNC1700Medicaid
NC5910136Medicaid
NC232009OtherMEDICARE PTAN, GROUP
NC232009OtherMEDICARE PTAN, GROUP
NC1164551198Medicaid