Provider Demographics
NPI:1396758678
Name:JOHNSON, DAVID RANDALL (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RANDALL
Last Name:JOHNSON
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 1:27 MOUNT BOLUS RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2638
Mailing Address - Country:US
Mailing Address - Phone:919-929-9777
Mailing Address - Fax:
Practice Address - Street 1:141 PROVIDENCE RD
Practice Address - Street 2:SUITE 230
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-6201
Practice Address - Country:US
Practice Address - Phone:919-493-0346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC297602084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCBJ0250302OtherDEA
NCBJ0250302OtherDEA
NC213278BMedicare ID - Type Unspecified