Provider Demographics
NPI:1972065639
Name:PRICE, JILL JOHNSON (DO)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:JOHNSON
Last Name:PRICE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ASHLYN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4355 HICKORY BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28630-2014
Mailing Address - Country:US
Mailing Address - Phone:828-757-5050
Mailing Address - Fax:
Practice Address - Street 1:4355 HICKORY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630-2014
Practice Address - Country:US
Practice Address - Phone:828-757-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-00997208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics