Healthcare Provider Details

I. General information

NPI: 1174579940
Provider Name (Legal Business Name): CLIFFORD PAUL JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 HOSPITAL DR SUITE 2A
HENDERSONVILLE NC
28792-5244
US

IV. Provider business mailing address

PO BOX 1869
FLETCHER NC
28732-1869
US

V. Phone/Fax

Practice location:
  • Phone: 828-654-6015
  • Fax: 828-687-6058
Mailing address:
  • Phone: 828-687-5616
  • Fax: 828-687-5616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number9501288
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: