Provider Demographics
NPI:1396717005
Name:JOHNSON, J BARRY (DPM)
Entity type:Individual
Prefix:
First Name:J
Middle Name:BARRY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3314 HEALY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1408
Mailing Address - Country:US
Mailing Address - Phone:336-768-1267
Mailing Address - Fax:336-768-9336
Practice Address - Street 1:3314 HEALY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1408
Practice Address - Country:US
Practice Address - Phone:336-768-1267
Practice Address - Fax:336-768-9336
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC75213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908095Medicaid
AJ4785474OtherFEDERAL DEA
243076BMedicare ID - Type Unspecified
NC8908095Medicaid
AJ4785474OtherFEDERAL DEA
NC1025270001Medicare NSC
NCT64042Medicare UPIN