Provider Demographics
NPI:1740628700
Name:JOHNSON, SAMUEL ARMAND
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:ARMAND
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-3107
Mailing Address - Country:US
Mailing Address - Phone:828-638-0010
Mailing Address - Fax:
Practice Address - Street 1:2005 SHANNON GRAY CT
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-9183
Practice Address - Country:US
Practice Address - Phone:336-307-4729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program