Provider Demographics
NPI:1194709675
Name:JOHNSON, ATLEE ROLLINS III (MD)
Entity type:Individual
Prefix:
First Name:ATLEE
Middle Name:ROLLINS
Last Name:JOHNSON
Suffix:III
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-633-9441
Mailing Address - Fax:704-637-9006
Practice Address - Street 1:911 W HENDERSON ST
Practice Address - Street 2:STE 110
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2736
Practice Address - Country:US
Practice Address - Phone:704-633-9441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33258208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8946509Medicaid
NCNCP235AMedicare PIN
NC213016CMedicare PIN
NCF18374Medicare UPIN