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General NPI Number Information
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NPI Number | 1730167651
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Entity Type | Individual
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Provider Name | TERRY D JOHNSON MD
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Gender | Male
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 12/04/2017
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Provider Practice Location Address
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Address Line | 2550 ELMS CENTER RD
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-9844
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Country | US
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Telephone | 843-302-8840
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Fax | 843-818-2188
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Provider Business Mailing Address
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Address Line | 201 SIGMA DR STE 100
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City | SUMMERVILLE
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State | SC
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Zip | 29486-7715
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Country | US
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Telephone | 843-793-5970
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Fax | 843-818-2187
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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 | 7353
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License Number State | SC
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