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General NPI Number Information
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NPI Number | 1609187517
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Entity Type | Individual
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Provider Name | CHARLES JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/24/2010
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 554 KEILY STREET
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City | JACKSONVILLE
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State | FL
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Zip | 32212
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Country | US
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Telephone | 757-953-7550
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Fax | 757-953-7560
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Provider Business Mailing Address
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Address Line | 554 KEILY STREET, BUREAU OF MEDICINE AND SURGERY CENTRALIZED CREDENTIAL AND PRIVILEGING DIRECTORATE
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City | JACKSONVILLE
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State | FL
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Zip | 32212
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Country | US
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Telephone | 757-953-7550
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Fax | 757-953-7560
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0101250181
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 89692
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME110710
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License Number State | FL
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