Provider Demographics
NPI:1326098385
Name:JOHNSON, KIRK H (MD)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:H
Last Name:JOHNSON
Suffix:
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 1:22 BETHEA DR
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-4702
Mailing Address - Country:US
Mailing Address - Phone:843-682-7480
Mailing Address - Fax:843-681-9169
Practice Address - Street 1:22 BETHEA DR
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-4702
Practice Address - Country:US
Practice Address - Phone:843-682-7480
Practice Address - Fax:843-681-9169
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA047281207X00000X
SC30514207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003108702Medicaid
MA0162388Medicaid
SCGP5241Medicaid
B76155Medicare UPIN
CT003108702Medicaid
SCGP5241Medicaid