MEDICARE: WILLIS JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	P021892	NC

General Provider Information

NPI Number	:	1407706054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIS JOHNSON

Provider Business Mailing Address
First Line	:	815 DALEWOOD DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1000
Country	:	US
Telephone Number	:	919-670-7895
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 DALEWOOD DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1000
Country	:	US
Telephone Number	:	919-670-7895
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	03/06/2026

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