Provider Demographics
NPI:1649460049
Name:JOHNSON, ALLISON EVANS (MD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:EVANS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:ALLISON
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:40 BRETTWOOD TRCE
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-8021
Mailing Address - Country:US
Mailing Address - Phone:828-456-8633
Mailing Address - Fax:828-452-2792
Practice Address - Street 1:40 BRETTWOOD TRCE
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8021
Practice Address - Country:US
Practice Address - Phone:828-456-8633
Practice Address - Fax:828-452-2792
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-2041208600000X
NC2013-01929208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery