Healthcare Provider Details

I. General information

NPI: 1891711156
Provider Name (Legal Business Name): GARRICK J JOHNSON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PLEASANT ST
CONCORD NH
03301-7559
US

IV. Provider business mailing address

200 TECHNOLOGY DRIVE NEW HAMPSHIRE ONCOLOGY HEMATOLOGY PA
HOOKSETT NH
03106
US

V. Phone/Fax

Practice location:
  • Phone: 603-622-6484
  • Fax: 603-622-7438
Mailing address:
  • Phone: 603-622-6484
  • Fax: 603-622-7438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0195P
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: