Provider Demographics
NPI:1346546512
Name:JOHNSON, OLAF KENNETH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:OLAF
Middle Name:KENNETH
Last Name:JOHNSON
Suffix:JR
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:P O BOX 70 ST JAMES PARISH CHILOMONI
Mailing Address - Street 2:
Mailing Address - City:BLANTYRE
Mailing Address - State:SOUTHERN PROVINCE
Mailing Address - Zip Code:CENTRAL AFRICA
Mailing Address - Country:MW
Mailing Address - Phone:26588-108-2440
Mailing Address - Fax:
Practice Address - Street 1:QUEEN ELIZABETH CENTRAL HOSPITAL
Practice Address - Street 2:
Practice Address - City:BLANTYRE
Practice Address - State:SOUTHERN PROVINCE
Practice Address - Zip Code:CENTRAL AFRICA
Practice Address - Country:MW
Practice Address - Phone:26588-108-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59619208600000X, 2086S0102X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology