Healthcare Provider Details

I. General information

NPI: 1750295564
Provider Name (Legal Business Name): JOHNSON PROSTHETICS & ORTHOTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 PHOENIX AVE STE A
FORT SMITH AR
72903-5092
US

IV. Provider business mailing address

1742 E JOYCE BLVD STE 1
FAYETTEVILLE AR
72703-5260
US

V. Phone/Fax

Practice location:
  • Phone: 479-222-9932
  • Fax: 479-222-2278
Mailing address:
  • Phone: 480-658-7811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL

VIII. Authorized Official

Name: GREG JOHNSON
Title or Position: CPO
Credential:
Phone: 479-485-3366