Provider Demographics
NPI:1619902442
Name:JOHNSON, JOEL M III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:M
Last Name:JOHNSON
Suffix:III
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 1:93 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1648
Mailing Address - Country:US
Mailing Address - Phone:843-681-3777
Mailing Address - Fax:843-681-9996
Practice Address - Street 1:93 MAIN ST
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-1648
Practice Address - Country:US
Practice Address - Phone:843-681-3777
Practice Address - Fax:843-681-9996
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30798207P00000X
SC18011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00335209OtherRAILROAD MEDICARE
SC582355948OtherBCBS
SCDA3517OtherRR MCR PTAN
P00168790OtherRAILROAD MEDICARE
GA884046OtherBLUE CROSS
GAD05612Medicare UPIN
GA93BBHPZMedicare PIN
GA93BFCNBMedicare PIN
SC582355948OtherBCBS
GA000365087JMedicaid
SC582355948OtherBCBS
P00168790OtherRAILROAD MEDICARE
SCGT6392Medicaid