Provider Demographics
NPI:1902399132
Name:JOHNSON, MICHAEL CREIGHTON (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CREIGHTON
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 5024 BLDG 99
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96319
Mailing Address - Country:US
Mailing Address - Phone:315-226-6211
Mailing Address - Fax:315-226-6113
Practice Address - Street 1:UNIT 5024 BLDG 99
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96319
Practice Address - Country:US
Practice Address - Phone:315-226-6111
Practice Address - Fax:315-226-6113
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider