Provider Demographics
NPI:1386454361
Name:JOHNSON, SCOTT ERIC (THD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ERIC
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:THD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 GODWIN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-6335
Mailing Address - Country:US
Mailing Address - Phone:910-403-6106
Mailing Address - Fax:
Practice Address - Street 1:2122 GODWIN LAKE RD
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-6335
Practice Address - Country:US
Practice Address - Phone:910-403-6106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner