Healthcare Provider Details

I. General information

NPI: 1497887293
Provider Name (Legal Business Name): MITZI JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 PLEASANT ST STE 201B
STOUGHTON MA
02072-2571
US

IV. Provider business mailing address

294 PLEASANT ST STE 201B
STOUGHTON MA
02072-2571
US

V. Phone/Fax

Practice location:
  • Phone: 781-344-0720
  • Fax: 781-344-0891
Mailing address:
  • Phone: 781-344-0720
  • Fax: 781-344-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number59642
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number59642
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number59642
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: