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General NPI Number Information
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NPI Number | 1588640700
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Entity Type | Individual
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Provider Name | MICHAEL ANTHONY JOHNSON MSW
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Gender | Male
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Dates
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Enumeration Date | 12/20/2005
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 28 MALLARD CT
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City | BECKLEY
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State | WV
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Zip | 25801-3664
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Country | US
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Telephone | 304-252-8409
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Fax | 304-252-0022
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Provider Business Mailing Address
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Address Line | 252 RURAL ACRES DR
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City | BECKLEY
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State | WV
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Zip | 25801-3503
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Country | US
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Telephone | 304-252-8409
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Fax | 304-252-0022
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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 | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | DP00939097
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License Number State | WV
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