Provider Demographics
NPI:1336138809
Name:JOHNSON, KEVIN EARL (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:EARL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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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:336-969-9158
Mailing Address - Fax:336-969-4554
Practice Address - Street 1:290 W WALL ST
Practice Address - Street 2:
Practice Address - City:RURAL HALL
Practice Address - State:NC
Practice Address - Zip Code:27045-9308
Practice Address - Country:US
Practice Address - Phone:336-969-9158
Practice Address - Fax:336-969-4554
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA070497207Q00000X
NC9801320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine