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General NPI Number Information
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NPI Number | 1275594079
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Entity Type | Individual
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Provider Name | EARLIE T JOHNSON JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 12/19/2012
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Provider Practice Location Address
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Address Line | 2580 HENDERSON DR
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City | JACKSONVILLE
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State | NC
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Zip | 28546-5252
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Country | US
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Telephone | 910-346-1188
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Fax | 910-346-1275
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Provider Business Mailing Address
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Address Line | 305 COUNTRY CLUB DR
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City | JACKSONVILLE
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State | NC
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Zip | 28546-7420
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Country | US
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Telephone | 910-347-1673
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 31729
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License Number State | NC
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