Provider Demographics
NPI:1780686626
Name:JOHNSON, KIM EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:EDWARD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 14767
Mailing Address - Street 2:NASH ANESTHESIA ASSOCIATES
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4042
Mailing Address - Country:US
Mailing Address - Phone:844-437-4275
Mailing Address - Fax:704-973-7896
Practice Address - Street 1:200 PROVIDENCE RD STE 101
Practice Address - Street 2:NASH ANESTHESIA ASSOCIATES
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1437
Practice Address - Country:US
Practice Address - Phone:844-437-4275
Practice Address - Fax:704-973-7896
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC31308207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2052241OtherUNITED HEALTHCARE
NC46398OtherBCBS NC
NC8946398Medicaid
NC46398OtherBCBS NC