Provider Demographics
NPI:1538468129
Name:JOHNSON, JOYCE PILAR (MD)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:PILAR
Last Name:JOHNSON
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:844-266-8268
Mailing Address - Fax:844-266-8268
Practice Address - Street 1:2950 PINE PLANTATION PKWY
Practice Address - Street 2:
Practice Address - City:OAK ISLAND
Practice Address - State:NC
Practice Address - Zip Code:28461-0119
Practice Address - Country:US
Practice Address - Phone:910-454-4032
Practice Address - Fax:910-454-4033
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-01555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1538468129Medicaid
NC1538468129Medicaid