Healthcare Provider Details

I. General information

NPI: 1235139387
Provider Name (Legal Business Name): ADOLPH WILLIAM JOHNSON JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 PROSPERITY DR STE 410
SILVER SPRING MD
20904-1652
US

IV. Provider business mailing address

12501 PROSPERITY DR STE 410
SILVER SPRING MD
20904-1652
US

V. Phone/Fax

Practice location:
  • Phone: 301-368-0038
  • Fax: 301-328-0006
Mailing address:
  • Phone: 301-368-0038
  • Fax: 301-328-0006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0033109
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: