Healthcare Provider Details

I. General information

NPI: 1952310831
Provider Name (Legal Business Name): LEVIE G JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 12/14/2025
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 6TH AVE
KINDER LA
70648
US

IV. Provider business mailing address

1236 MARINA DR
SLIDELL LA
70458-9212
US

V. Phone/Fax

Practice location:
  • Phone: 337-738-9476
  • Fax: 337-738-9410
Mailing address:
  • Phone: 985-856-2623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number08482R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.08482R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: