Healthcare Provider Details

I. General information

NPI: 1639572308
Provider Name (Legal Business Name): ALISON JOHNSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 HARRINGTON ST STE 1
NEWBERRY SC
29108-3088
US

IV. Provider business mailing address

1910 GREGG ST
COLUMBIA SC
29201-2618
US

V. Phone/Fax

Practice location:
  • Phone: 803-321-3035
  • Fax: 803-331-3034
Mailing address:
  • Phone: 803-779-1420
  • Fax: 803-931-0676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1121199
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: