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General NPI Number Information
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NPI Number | 1467751495
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Entity Type | Organization
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Legal Business Name | DR. TERRY D. JOHNSON, P.A.
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Dates
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Enumeration Date | 03/16/2011
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Last Update Date | 06/03/2011
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Provider Practice Location Address
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Address Line | 511 N HIGHWAY 52
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City | MONCKS CORNER
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State | SC
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Zip | 29461-3132
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Country | US
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Telephone | 843-761-0936
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Fax | 843-761-0938
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Provider Business Mailing Address
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Address Line | PO BOX 17190 MEDICAL STAFF OFFICE
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City | LAS VEGAS
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State | NV
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Zip | 89114-7190
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Country | US
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Telephone | 702-560-2916
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Fax | 702-560-2928
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Authorized Official
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Title or Position | PRESIDENT / CEO
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Name | DR. TERRY DUANE JOHNSON
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Credential | M.D.
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Telephone | 864-590-6561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 7353
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License Number State | SC
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