Healthcare Provider Details

I. General information

NPI: 1922560747
Provider Name (Legal Business Name): PAIGE JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST # 520
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

500 S UNIVERSITY AVE STE 101
LITTLE ROCK AR
72205-5314
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-6627
  • Fax:
Mailing address:
  • Phone: 501-686-2688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number67905
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberE-19126
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: