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General NPI Number Information
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NPI Number | 1659368629
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Entity Type | Individual
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Provider Name | STEPHANIE M JOHNSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 301 HENRY ST
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City | NORTH VERNON
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State | IN
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Zip | 47265-1030
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Country | US
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Telephone | 812-352-4454
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Fax | 812-418-4230
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Provider Business Mailing Address
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Address Line | 2794 BUTTERCUP CT E
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City | COLUMBUS
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State | IN
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Zip | 47201-3041
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Country | US
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Telephone | 812-418-4230
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Fax | 812-418-4230
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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 | 01054624A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 01054624A
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License Number State | IN
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