Provider Demographics
NPI:1942224936
Name:JOHNSON, NATHALIE GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:NATHALIE
Middle Name:GEORGE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NATHALIE
Other - Middle Name:GEORGE
Other - Last Name:MCDOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9155 SW BARNES RD
Mailing Address - Street 2:SUITE 830
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6625
Mailing Address - Country:US
Mailing Address - Phone:503-229-7431
Mailing Address - Fax:503-292-1433
Practice Address - Street 1:1130 NW 22ND AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2900
Practice Address - Country:US
Practice Address - Phone:503-229-7431
Practice Address - Fax:503-292-1433
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17901208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR044532Medicaid
OR044532Medicaid
OROOWCGDGFMedicare PIN