Provider Demographics
NPI:1427487818
Name:DARRYL JOHNSON AGENCY INC
Entity type:Organization
Organization Name:DARRYL JOHNSON AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-373-7043
Mailing Address - Street 1:715 N CHURCH ST
Mailing Address - Street 2:STE 130
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2294
Mailing Address - Country:US
Mailing Address - Phone:704-373-7043
Mailing Address - Fax:704-373-7045
Practice Address - Street 1:715 N CHURCH ST
Practice Address - Street 2:STE 130
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2294
Practice Address - Country:US
Practice Address - Phone:704-373-7043
Practice Address - Fax:704-373-7045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8480713302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization