Provider Demographics
NPI:1588727747
Name:JOHNSON, CECILY MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:CECILY
Middle Name:MICHELLE
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 1:1215 N BISHOP AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4118
Mailing Address - Country:US
Mailing Address - Phone:214-675-0906
Mailing Address - Fax:
Practice Address - Street 1:3920 W WHEATLAND RD
Practice Address - Street 2:SUITE 108
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3401
Practice Address - Country:US
Practice Address - Phone:214-948-7779
Practice Address - Fax:904-244-3658
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN10521207V00000X
TXN3103207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology