Provider Demographics
NPI:1528064698
Name:JOHNSON, PATRICIA JUNE (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:JUNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 TALLULAH RD
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28771-8500
Mailing Address - Country:US
Mailing Address - Phone:828-479-6434
Mailing Address - Fax:828-479-2917
Practice Address - Street 1:409 TALLULAH RD
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28771-8500
Practice Address - Country:US
Practice Address - Phone:828-479-6434
Practice Address - Fax:828-479-2917
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC207621-AMedicare ID - Type Unspecified
NCC84746Medicare UPIN