Healthcare Provider Details

I. General information

NPI: 1326295387
Provider Name (Legal Business Name): WILLIAM LEE JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 01/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 SAINT MARYS RD
JUNCTION CITY KS
66441-4139
US

IV. Provider business mailing address

1102 SAINT MARYS RD
JUNCTION CITY KS
66441-4139
US

V. Phone/Fax

Practice location:
  • Phone: 785-210-3356
  • Fax:
Mailing address:
  • Phone: 785-210-3356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number41931
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101243295
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number586
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number04-34859
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: