Healthcare Provider Details

I. General information

NPI: 1891054110
Provider Name (Legal Business Name): DR. WARREN H. JOHNSON, PODIATRIST, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 05/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 ELYSIAN FIELDS AVE SUITE 204
NEW ORLEANS LA
70122-4245
US

IV. Provider business mailing address

6305 ELYSIAN FIELDS AVE SUITE 204
NEW ORLEANS LA
70122-4245
US

V. Phone/Fax

Practice location:
  • Phone: 504-286-0202
  • Fax: 504-286-0702
Mailing address:
  • Phone: 504-286-0202
  • Fax: 504-286-0702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number207800
License Number StateLA

VIII. Authorized Official

Name: DR. CAROLYN J. JOHNSON
Title or Position: VP/ADMINISTRATOR
Credential: PH.D.
Phone: 504-286-0202