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General NPI Number Information
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NPI Number | 1184629776
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Entity Type | Individual
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Provider Name | CAROL G JOHNSON MD
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Gender | Female
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 07/01/2024
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Provider Practice Location Address
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Address Line | 1030 E COUNTY LINE RD STE B2
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-2933
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Country | US
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Telephone | 317-887-6060
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Fax | 317-859-5946
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Provider Business Mailing Address
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Address Line | 2086 FOX MOOR TER
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City | GREENWOOD
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State | IN
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Zip | 46143-9276
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Country | US
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Telephone | 317-887-3519
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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 | 01037716
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License Number State | IN
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