Provider Demographics
NPI:1528772480
Name:JOHNSONS FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:JOHNSONS FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP, BC
Authorized Official - Phone:850-215-7095
Mailing Address - Street 1:2605 THOMAS DR STE 120
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-6254
Mailing Address - Country:US
Mailing Address - Phone:850-215-7095
Mailing Address - Fax:850-215-7096
Practice Address - Street 1:2605 THOMAS DR STE 120
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-6254
Practice Address - Country:US
Practice Address - Phone:850-215-7095
Practice Address - Fax:850-215-7096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN9307095OtherAPRN