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General NPI Number Information
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NPI Number | 1073653945
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Entity Type | Individual
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Provider Name | EMILY KATHLEEN JOHNSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 06/20/2016
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Provider Practice Location Address
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Address Line | 2016 1ST AVE
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City | SUMMERVILLE
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State | SC
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Zip | 29486-0408
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Country | US
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Telephone | 843-873-4545
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Fax | 843-873-1561
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Provider Business Mailing Address
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Address Line | 704 N SHORE DR
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City | CHARLESTON
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State | SC
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Zip | 29412-4216
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Country | US
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Telephone | 502-235-3114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 38009
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License Number State | SC
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