Healthcare Provider Details

I. General information

NPI: 1760566863
Provider Name (Legal Business Name): CHARLES MURRAY JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 WILLIAM HOWARD TAFT RD
CINCINNATI OH
45219-2103
US

IV. Provider business mailing address

8170 MISTY CV
MAINEVILLE OH
45039-8709
US

V. Phone/Fax

Practice location:
  • Phone: 513-616-8774
  • Fax: 513-861-0105
Mailing address:
  • Phone: 513-616-8774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35-036772
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35-036772
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: