Provider Demographics
NPI:1881736023
Name:JOHNSON, MARTIN DANIEL
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:DANIEL
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 1:23 BEAVER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-1802
Mailing Address - Country:US
Mailing Address - Phone:828-254-4032
Mailing Address - Fax:828-254-4032
Practice Address - Street 1:23 BEAVER VALLEY RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-1802
Practice Address - Country:US
Practice Address - Phone:828-254-4032
Practice Address - Fax:828-254-4032
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409307Medicaid