Healthcare Provider Details

I. General information

NPI: 1265492318
Provider Name (Legal Business Name): JOSEPH EDWARD JOHNSON PA/C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 PERDIDO ST SE LOUISIANA HCS, ID SECTION
NEW ORLEANS LA
70112-1262
US

IV. Provider business mailing address

622 MARIGNY ST
NEW ORLEANS LA
70117-8522
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-0811
  • Fax:
Mailing address:
  • Phone: 504-948-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: