Provider Demographics
NPI:1528152717
Name:CHARLES R. JOHNSON MD, INC.
Entity type:Organization
Organization Name:CHARLES R. JOHNSON MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIGNON
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-267-4255
Mailing Address - Street 1:PO BOX 15160
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92175-5160
Mailing Address - Country:US
Mailing Address - Phone:619-267-4255
Mailing Address - Fax:619-267-7937
Practice Address - Street 1:2400 E 8TH ST
Practice Address - Street 2:STE A
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950
Practice Address - Country:US
Practice Address - Phone:619-267-4255
Practice Address - Fax:619-267-7937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty