Provider Demographics
NPI:1891711156
Name:JOHNSON, GARRICK J (PA)
Entity Type:Individual
Prefix:
First Name:GARRICK
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TECHNOLOGY DRIVE
Mailing Address - Street 2:NEW HAMPSHIRE ONCOLOGY HEMATOLOGY PA
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106
Mailing Address - Country:US
Mailing Address - Phone:603-622-6484
Mailing Address - Fax:603-622-7438
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7559
Practice Address - Country:US
Practice Address - Phone:603-622-6484
Practice Address - Fax:603-622-7438
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0195P363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30330699Medicaid
NH970014040Medicare PIN
NHRE8439Medicare PIN
NHP00633043Medicare PIN
NHAP1190Medicare PIN
NH30330699Medicaid