Healthcare Provider Details

I. General information

NPI: 1770288474
Provider Name (Legal Business Name): CARRIE MARGARET JOHNSON MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

IV. Provider business mailing address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

V. Phone/Fax

Practice location:
  • Phone: 207-248-5000
  • Fax: 207-626-1648
Mailing address:
  • Phone: 207-248-5000
  • Fax: 207-626-1648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD30620
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number33504
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number86755-20
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number77564
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: