Provider Demographics
NPI:1467747436
Name:JOHNSON, GRAHAM OLIVER CHILDS (MD)
Entity Type:Individual
Prefix:
First Name:GRAHAM
Middle Name:OLIVER CHILDS
Last Name:JOHNSON
Suffix:
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 1:5800 WALNUT ST
Mailing Address - Street 2:REAR (SAYRE HEALTH CENTER)
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-3836
Mailing Address - Country:US
Mailing Address - Phone:215-474-4444
Mailing Address - Fax:
Practice Address - Street 1:5800 WALNUT ST
Practice Address - Street 2:REAR (SAYRE HEALTH CENTER)
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3836
Practice Address - Country:US
Practice Address - Phone:215-474-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD451937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine