Provider Demographics
NPI:1891054110
Name:DR. WARREN H. JOHNSON, PODIATRIST, PC
Entity type:Organization
Organization Name:DR. WARREN H. JOHNSON, PODIATRIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:504-286-0202
Mailing Address - Street 1:6305 ELYSIAN FIELDS AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-4245
Mailing Address - Country:US
Mailing Address - Phone:504-286-0202
Mailing Address - Fax:504-286-0702
Practice Address - Street 1:6305 ELYSIAN FIELDS AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-4245
Practice Address - Country:US
Practice Address - Phone:504-286-0202
Practice Address - Fax:504-286-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207800261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1969435Medicaid
LA1969435Medicaid