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General NPI Number Information
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NPI Number | 1639317647
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Entity Type | Individual
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Provider Name | SARAH CARLOTA JOHNSON P.A.
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Gender | Female
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Dates
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Enumeration Date | 01/29/2009
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Last Update Date | 01/29/2009
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Provider Practice Location Address
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Address Line | 3825 HIGHLAND AVE STE 5C
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1552
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Country | US
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Telephone | 630-964-2000
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Fax | 630-964-6378
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Provider Business Mailing Address
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Address Line | 3825 HIGHLAND AVE STE 5C
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1552
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Country | US
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Telephone | 630-964-2000
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Fax | 630-964-6378
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 085003336
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License Number State | IL
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