Provider Demographics
NPI:1316987043
Name:JOHANSON, WILLIAM THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:JOHANSON
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:PO BOX 1490
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-1490
Mailing Address - Country:US
Mailing Address - Phone:828-262-3886
Mailing Address - Fax:828-265-4816
Practice Address - Street 1:301 E MEETING ST STE 101
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3594
Practice Address - Country:US
Practice Address - Phone:828-608-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8946028Medicaid
NCAJ9529756OtherDEA
NC2202815FMedicare ID - Type Unspecified
NCAJ9529756OtherDEA
NC2202815KMedicare PIN