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General NPI Number Information
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NPI Number | 1548892201
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Entity Type | Organization
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Legal Business Name | K JOHNSON MD
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 07/28/2020
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Provider Practice Location Address
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Address Line | 5016 W GENESEE ST
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City | CAMILLUS
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State | NY
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Zip | 13031-2356
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Country | US
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Telephone | 315-320-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 5016 W GENESEE ST
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City | CAMILLUS
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State | NY
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Zip | 13031-2356
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Country | US
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Telephone | 315-320-7900
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN JOHNSON
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Credential | MD
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Telephone | 315-320-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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