Provider Demographics
NPI:1942237078
Name:JOHNSON, CHRISTOPHER R (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-9003
Mailing Address - Country:US
Mailing Address - Phone:903-676-3200
Mailing Address - Fax:903-676-3277
Practice Address - Street 1:117 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-9003
Practice Address - Country:US
Practice Address - Phone:903-676-3200
Practice Address - Fax:903-676-3277
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7562207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092333603Medicaid
P02707038OtherRAILROAD MEDICARE
H08VF37301OtherBCBS
TX8P8811OtherBLUE CROSS BLUE SHIELD
TX110211232OtherRAILROAD MEDICARE
TX110211232OtherRAILROAD MEDICARE
TX8B3815Medicare ID - Type Unspecified