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NPI Code Detail

MEDICARE: DR. LAUREL J JENNINGS JOHNSON MD

MEDICARE:  DR. LAUREL J JENNINGS JOHNSON  MD
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
1207Q00000XFamily Medicine Physician5501SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891772521
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAUREL J JENNINGS JOHNSON MD
Provider Business Mailing Address
First Line : 323 SW 10TH ST
Second Line :
City : MADISON
State : SD
Zip : 57042-3200
Country : US
Telephone Number : 605-256-6951
Fax Number : 605-256-6953
Provider Business Practice Location Address
First Line : 323 SW 10TH ST
Second Line :
City : MADISON
State : SD
Zip : 57042-3200
Country : US
Telephone Number : 605-256-6951
Fax Number : 605-256-6953
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2005
Last Update Date : 03/02/2016

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Directions to “ DR. LAUREL J JENNINGS JOHNSON MD” Practice Location

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