Healthcare Provider Details

I. General information

NPI: 1487094207
Provider Name (Legal Business Name): CAROLYN M JOHNSON MD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E ST NW L209
WASHINGTON DC
20520-5712
US

IV. Provider business mailing address

2817 REILLY ST WOMACK ARMY MEDICAL CENTER
FORT BRAGG NC
28310-7324
US

V. Phone/Fax

Practice location:
  • Phone: 202-663-1643
  • Fax:
Mailing address:
  • Phone: 910-907-8922
  • Fax: 910-907-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMRM-1339
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19893
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: