JOHNSON, MELISSA A (PA-C)

Provider Demographics

• NPI: 1437399201
• Name: JOHNSON, MELISSA A (PA-C)
• Entity Type: Individual
• First Name: MELISSA
• Middle Name: A
• Last Name: JOHNSON
• Gender: F
• Credentials: PA-C
• Mailing Address - Street 1: 225 BALDWIN AVE
• Mailing Address - City: CHARLOTTE
• Mailing Address - State: NC
• Mailing Address - Zip Code: 28204-3109
• Mailing Address - Country: US
• Mailing Address - Phone: 704-376-1605
• Mailing Address - Fax: 704-335-8448
• Practice Address - Street 1: 225 BALDWIN AVE
• Practice Address - City: CHARLOTTE
• Practice Address - State: NC
• Practice Address - Zip Code: 28204-3109
• Practice Address - Country: US
• Practice Address - Phone: 704-376-1605
• Practice Address - Fax: 704-335-8448
• Is Sole Proprietor?: No
• Enumeration Date: 2009-03-05
• Last Update Date: 2020-12-22

Provider Licenses

State	License ID	Taxonomies
NC	0010-01756	363A00000X, 363AS0400X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	363AS0400X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant	Surgical
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NC	8102473	Medicaid
NC	1437399201	Medicaid
NC	NC7029C	Medicare PIN
NC	NC7029M	Medicare PIN
NC	NC7029A	Medicare PIN
NC	2009388	Medicare PIN
NC	NC7029P	Medicare UPIN
NC	NC7029Q	Medicare PIN
NC	1437399201	Medicaid
NC	NC7029F	Medicare PIN
NC	NC7029H	Medicare PIN
NC	NC7029N	Medicare PIN
NC	NC7029O	Medicare PIN
NC	NC7029I	Medicare PIN
NC	NC7029J	Medicare PIN
NC	NC7029K	Medicare PIN
NC	2760066	Medicare PIN
NC	NC7029D	Medicare PIN
NC	NC7029B	Medicare PIN
NC	8102473	Medicaid
NC	NC7029G	Medicare PIN
NC	NC7029R	Medicare PIN