Provider Demographics
NPI:1487665873
Name:GARFIELD JOHNSONJR. M.D., PC
Entity Type:Organization
Organization Name:GARFIELD JOHNSONJR. M.D., PC
Other - Org Name:GARFIELD JOHNSON JR, M.D., PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARFIELD
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:248-253-2340
Mailing Address - Street 1:461 W HURON ST
Mailing Address - Street 2:5 SOUTH
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1601
Mailing Address - Country:US
Mailing Address - Phone:248-253-2340
Mailing Address - Fax:248-857-6919
Practice Address - Street 1:461 W HURON ST
Practice Address - Street 2:5 SOUTH
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1601
Practice Address - Country:US
Practice Address - Phone:248-253-2340
Practice Address - Fax:248-857-6919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGJ028356207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1606341612OtherBCBS
MI1619916343OtherIND PROVIDER NPI
MI=========OtherTAX ID
MI1619916343OtherIND PROVIDER NPI
MIB44273Medicare UPIN