Provider Demographics
NPI:1831169036
Name:JOHNSON, SONYA FURNAE CAMPBELL (MD)
Entity type:Individual
Prefix:DR
First Name:SONYA
Middle Name:FURNAE CAMPBELL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:931 E 86TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1860
Mailing Address - Country:US
Mailing Address - Phone:317-257-1484
Mailing Address - Fax:317-257-1488
Practice Address - Street 1:931 E 86TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1860
Practice Address - Country:US
Practice Address - Phone:317-257-1484
Practice Address - Fax:317-257-1488
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01049424A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200209210Medicaid
IN132230Medicare PIN
ING877075Medicare UPIN