Provider Demographics
NPI:1215956644
Name:JOHNSON, CHRISTINA A (MD)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:A
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:202 FRANKLIN STREET
Mailing Address - Street 2:P O BOX 128
Mailing Address - City:WARSAW
Mailing Address - State:KY
Mailing Address - Zip Code:41095-4304
Mailing Address - Country:US
Mailing Address - Phone:859-567-2754
Mailing Address - Fax:859-567-5108
Practice Address - Street 1:202 FRANKLIN STREET
Practice Address - Street 2:WARSAW FAMILY PRACTICE
Practice Address - City:WARSAW
Practice Address - State:KY
Practice Address - Zip Code:41095-4304
Practice Address - Country:US
Practice Address - Phone:859-567-2754
Practice Address - Fax:859-567-5108
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64110646Medicaid
KY64110646Medicaid
KYI42504Medicare UPIN