Provider Demographics
NPI:1811073950
Name:JOHNSON, JOSETTE JAQUELINE (M D)
Entity type:Individual
Prefix:DR
First Name:JOSETTE
Middle Name:JAQUELINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:M D
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Mailing Address - Street 1:3 SAINT FRANCIS DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3971
Mailing Address - Country:US
Mailing Address - Phone:864-235-8396
Mailing Address - Fax:864-271-4092
Practice Address - Street 1:3 SAINT FRANCIS DR
Practice Address - Street 2:SUITE 400
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3971
Practice Address - Country:US
Practice Address - Phone:864-235-8396
Practice Address - Fax:864-271-4092
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2015-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC13921207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC139219Medicaid
SCD17655Medicare UPIN
SC139219Medicaid