Healthcare Provider Details

I. General information

NPI: 1073540159
Provider Name (Legal Business Name): CARROLL DON JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N CHURCH ST
ATKINS AR
72823-3234
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 479-480-4066
  • Fax:
Mailing address:
  • Phone: 870-347-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE2435
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: