Healthcare Provider Details

I. General information

NPI: 1184615437
Provider Name (Legal Business Name): DONALD R JOHNSON II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 CHUCK DAWLEY BLVD SUITE 200
MT PLEASANT SC
29464-4183
US

IV. Provider business mailing address

217 DOZIER BLVD SUITE 100
FLORENCE SC
29501-4090
US

V. Phone/Fax

Practice location:
  • Phone: 843-849-1551
  • Fax: 843-849-6591
Mailing address:
  • Phone: 843-669-5162
  • Fax: 843-667-4573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number12300
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: