Provider Demographics
NPI:1841378205
Name:JOHNSON, DAVID S (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 W WEBB AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217
Mailing Address - Country:US
Mailing Address - Phone:336-228-8316
Mailing Address - Fax:336-227-9750
Practice Address - Street 1:530 W WEBB AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-3706
Practice Address - Country:US
Practice Address - Phone:336-228-8316
Practice Address - Fax:336-227-9750
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24916208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1200811OtherUHC
NC8946112Medicaid
NC46112OtherBCBS
NC46112OtherBCBS