Healthcare Provider Details

I. General information

NPI: 1154173896
Provider Name (Legal Business Name): WILLIAM KEHOE JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR CB#7510 2000 OLD CLINIC SUITE W2107
CHAPEL HILL NC
27599-7510
US

IV. Provider business mailing address

101 MANNING DR CB#7510 2000 OLD CLINIC SUITE W2107
CHAPEL HILL NC
27599-7510
US

V. Phone/Fax

Practice location:
  • Phone: 919-445-6985
  • Fax: 919-962-9625
Mailing address:
  • Phone: 919-445-6985
  • Fax: 919-962-9625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2025-03433
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: