Provider Demographics
NPI:1598039505
Name:STANCIL E.D. JOHNSON, M.D, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:STANCIL E.D. JOHNSON, M.D, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR, M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:STANCIL
Authorized Official - Middle Name:ED
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-625-2626
Mailing Address - Street 1:P.O. BOX 5396
Mailing Address - Street 2:CARMEL POST OFFICE
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93921
Mailing Address - Country:US
Mailing Address - Phone:831-625-2626
Mailing Address - Fax:831-625-1245
Practice Address - Street 1:JUNIPERO ST BTWN 4TH & 5TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93920
Practice Address - Country:US
Practice Address - Phone:831-625-2626
Practice Address - Fax:831-625-1245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC289352084P0800X
CAC289350-CA2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC289350CAOtherMC LICENSE
CAA33789Medicare PIN