Healthcare Provider Details

I. General information

NPI: 1558446948
Provider Name (Legal Business Name): LAUREN PATRICIA JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NCSU SHS 2815 CATES AVE
RALEIGH NC
27695-7304
US

IV. Provider business mailing address

NCSU SHS 2815 CATES AVE; PO BOX 7304
RALEIGH NC
27695-7304
US

V. Phone/Fax

Practice location:
  • Phone: 919-515-2563
  • Fax: 188-897-2415
Mailing address:
  • Phone: 919-515-2563
  • Fax: 188-897-2415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number200101072
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number200101072
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: