Provider Demographics
NPI:1407811771
Name:JOHNS, SUSAN G (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:JOHNS
Suffix:
Gender:F
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 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-272-5100
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:115 HUSTON DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7250
Practice Address - Country:US
Practice Address - Phone:502-955-7311
Practice Address - Fax:502-955-9694
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27734207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000052154COtherHUMANA / NMA
2435117000OtherPASSPORT ADVANTAGE / NMA
2138920002OtherCIGNA / NMA
KYP00181542OtherRAILROAD MEDICARE
000000350680OtherANTHEM / NMA
1193978OtherCHA / NMA
012906OtherSIHO / NMA
1073671OtherPASSPORT / NMA
KY64277346Medicaid
KYP00181542OtherRAILROAD MEDICARE
KY0361942Medicare PIN