Provider Demographics
NPI:1558337022
Name:JOHNSON, JAMES LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEWIS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:44 MCCOY AVE, BOX 9
Mailing Address - Street 2:HEART CARE ASSOCIATES, PSC
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-2867
Mailing Address - Country:US
Mailing Address - Phone:270-821-0677
Mailing Address - Fax:270-821-2539
Practice Address - Street 1:44 MCCOY AVE
Practice Address - Street 2:HEART CARE ASSOCIATES, PSC
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-2867
Practice Address - Country:US
Practice Address - Phone:270-821-0677
Practice Address - Fax:270-821-2539
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20960207RC0000X
TNMD0000036916207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64209604Medicaid
KY000000670343OtherANTHEM BLUE CROSS AND BLUE SHIELD
KY000000670343OtherANTHEM BLUE CROSS AND BLUE SHIELD
KY64209604Medicaid