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General NPI Number Information
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NPI Number | 1538166673
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Entity Type | Individual
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Provider Name | JAMES R JOHANSEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 708 MCBRAYER HOMESTEAD RD
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City | SHELBY
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State | NC
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Zip | 28152-9532
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Country | US
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Telephone | 704-484-8123
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Fax | 704-434-7262
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Provider Business Mailing Address
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Address Line | PO BOX 778
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City | BOILING SPRINGS
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State | NC
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Zip | 28017-0778
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Country | US
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Telephone | 704-434-8123
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Fax | 704-434-7262
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9600957
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License Number State | NC
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