Healthcare Provider Details

I. General information

NPI: 1922636240
Provider Name (Legal Business Name): ERIC COLEMAN JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 STANYAN ST
SAN FRANCISCO CA
94117-1019
US

IV. Provider business mailing address

100 WOODRUFF CIR NE
ATLANTA GA
30322-1020
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1482
  • Fax:
Mailing address:
  • Phone: 404-712-6331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0095726
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number15352
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA201441
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: