Provider Demographics
NPI:1962778118
Name:JOHNSON, ALYSON MCGHAN (MD)
Entity type:Individual
Prefix:DR
First Name:ALYSON
Middle Name:MCGHAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:ADRIANA
Other - Last Name:MCGHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PRIVATE DIAGNOSTIC CLINIC, PLLC
Mailing Address - Street 2:5213 SOUTH ALSTON AVENUE
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:919-684-8111
Mailing Address - Fax:
Practice Address - Street 1:3480 WAKE FOREST RD STE 500
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7376
Practice Address - Country:US
Practice Address - Phone:919-684-6437
Practice Address - Fax:919-681-8147
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-31
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201600412207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
9196848111OtherWORK PHONE