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General NPI Number Information
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NPI Number | 1326280991
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Entity Type | Individual
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Provider Name | KEVIN ANTHONY JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/29/2009
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 1400 HANCOCK BLVD #1208
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City | DAYTONA BEACH
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State | FL
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Zip | 32114
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Country | US
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Telephone | 386-252-2524
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Fax |
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Provider Business Mailing Address
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Address Line | 3602 S LOYOLA DR APT 296
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City | KENNER
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State | LA
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Zip | 70065-6429
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Country | US
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Telephone | 504-275-7264
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 205288
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License Number State | LA
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