Provider Demographics
NPI:1336138809
Name:JOHNSON, KEVIN EARL (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:EARL
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 1:3409 THOMASVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-5438
Mailing Address - Country:US
Mailing Address - Phone:743-229-3300
Mailing Address - Fax:743-229-3324
Practice Address - Street 1:3409 THOMASVILLE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-5438
Practice Address - Country:US
Practice Address - Phone:743-229-3300
Practice Address - Fax:743-229-3324
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801320207Q00000X
GA070497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine