Provider Demographics
NPI:1932247053
Name:JOHNSON, GEORGE P (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:P
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 N CIRCLE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1177
Mailing Address - Country:US
Mailing Address - Phone:719-475-9496
Mailing Address - Fax:719-776-4802
Practice Address - Street 1:3030 N CIRCLE DR STE 210
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1180
Practice Address - Country:US
Practice Address - Phone:719-776-4800
Practice Address - Fax:719-776-4802
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010412972083A0100X
CO501142083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine