Provider Demographics
NPI:1184815581
Name:JOHNSTON MEMORIAL HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:JOHNSTON MEMORIAL HOSPITAL AUTHORITY
Other - Org Name:JOHNSTON INFECTIOUS DISEASE AND INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-938-7128
Mailing Address - Street 1:509 N BRIGHTLEAF BLVD
Mailing Address - Street 2:PO BOX 1376
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4407
Mailing Address - Country:US
Mailing Address - Phone:919-934-8171
Mailing Address - Fax:
Practice Address - Street 1:507 N BRIGHTLEAF BLVD
Practice Address - Street 2:SUITE 201 MEDICAL ARTS BLDG
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4405
Practice Address - Country:US
Practice Address - Phone:919-934-8544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0151207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty