Provider Demographics
NPI:1639228992
Name:JOHNSON, VERNON CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:CHARLES
Last Name:JOHNSON
Suffix:
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 1:302 E BROCKETT ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-4932
Mailing Address - Country:US
Mailing Address - Phone:903-893-1400
Mailing Address - Fax:903-893-6090
Practice Address - Street 1:302 E BROCKETT ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-4932
Practice Address - Country:US
Practice Address - Phone:903-893-1400
Practice Address - Fax:903-893-6090
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ08412084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
00T08MOtherBLUE CROSS BLUE SHIELD
OK100164380AMedicaid
TX128802905Medicaid