Provider Demographics
NPI:1346550829
Name:JOHNSON, ANDREW COLE (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:COLE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SAINT DUNSTANS RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2790
Mailing Address - Country:US
Mailing Address - Phone:828-252-4020
Mailing Address - Fax:828-252-4022
Practice Address - Street 1:1 SAINT DUNSTANS RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2790
Practice Address - Country:US
Practice Address - Phone:828-252-4020
Practice Address - Fax:828-252-4022
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2940731206363AS0400X
NC0010-04367363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1346550829Medicaid
NC19EL2OtherBCBS-NC
NCNCE332BMedicare PIN