Provider Demographics
NPI:1205866985
Name:JOHNSON, SALLY SPERRING (MD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:SPERRING
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3047
Mailing Address - Country:US
Mailing Address - Phone:812-360-7286
Mailing Address - Fax:
Practice Address - Street 1:923 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3047
Practice Address - Country:US
Practice Address - Phone:812-360-7286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035224A207P00000X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100316970Medicaid
IN01035224AOtherINDIANA LICENSE
IN01035224BOtherCSR
IN01035224BOtherCSR
494620NMedicare ID - Type Unspecified
BS0696623OtherDEA