Healthcare Provider Details

I. General information

NPI: 1356684443
Provider Name (Legal Business Name): ELIZABETH JOHNSON SUMNER MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH BRADLEY JOHNSON MD

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 VEAZEY RD CENTRAL REGIONAL HOSPITAL
BUTNER NC
27509
US

IV. Provider business mailing address

300 VEAZEY RD CENTRAL REGIONAL HOSPITAL
BUTNER NC
27509
US

V. Phone/Fax

Practice location:
  • Phone: 919-764-2000
  • Fax:
Mailing address:
  • Phone: 919-764-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2016-00062
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: