Provider Demographics
NPI:1861680373
Name:JOHNSON, SALLY A (DO)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2727 HOLLYCROFT STREET
Mailing Address - Street 2:SUITE 390
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1305
Mailing Address - Country:US
Mailing Address - Phone:253-777-2077
Mailing Address - Fax:253-432-4137
Practice Address - Street 1:2727 HOLLYCROFT STREET
Practice Address - Street 2:SUITE 390
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1305
Practice Address - Country:US
Practice Address - Phone:253-777-2077
Practice Address - Fax:253-432-4137
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP6001031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine