Healthcare Provider Details

I. General information

NPI: 1700939220
Provider Name (Legal Business Name): ANDREA MARIE JOHNSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N COX ST STE 28
ASHEBORO NC
27203-5514
US

IV. Provider business mailing address

350 N COX ST STE 28
ASHEBORO NC
27203-5514
US

V. Phone/Fax

Practice location:
  • Phone: 336-629-6500
  • Fax: 336-629-9500
Mailing address:
  • Phone: 336-629-6500
  • Fax: 336-629-9500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103798
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: