Provider Demographics
NPI:1376229922
Name:JOHNSON, ERICA D
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 REMOUNT RD STE C1
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6459
Mailing Address - Country:US
Mailing Address - Phone:980-533-1084
Mailing Address - Fax:
Practice Address - Street 1:125 REMOUNT RD STE C1
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6459
Practice Address - Country:US
Practice Address - Phone:980-533-1084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor