Provider Demographics
NPI:1346243052
Name:JOHNSON, JAMES ERWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ERWIN
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:PO BOX 87089
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-7089
Mailing Address - Country:US
Mailing Address - Phone:910-484-3114
Mailing Address - Fax:910-484-8824
Practice Address - Street 1:3308 MELROSE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-1604
Practice Address - Country:US
Practice Address - Phone:910-484-3114
Practice Address - Fax:910-484-8824
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23040207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8946289Medicaid
NC8946289Medicaid
NC207615Medicare ID - Type Unspecified