Provider Demographics
NPI:1790705796
Name:JOHNSON, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 SINGLETON RIDGE RD
Mailing Address - Street 2:ATTN PATIENT ACCOUNTING
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9142
Mailing Address - Country:US
Mailing Address - Phone:843-234-6946
Mailing Address - Fax:
Practice Address - Street 1:1600 FARROW PARKWAY
Practice Address - Street 2:UNIT B3
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-2011
Practice Address - Country:US
Practice Address - Phone:843-839-4095
Practice Address - Fax:843-839-4096
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-09-21
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Provider Licenses
StateLicense IDTaxonomies
NC200000236207R00000X
SC35605207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH12493Medicare UPIN