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General NPI Number Information
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NPI Number | 1780667501
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Entity Type | Individual
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Provider Name | STEPHEN E. JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/25/2005
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Last Update Date | 02/04/2014
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Provider Practice Location Address
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Address Line | 6602 KNIGHTDALE BLVD SUITE 102
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City | KNIGHTDALE
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State | NC
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Zip | 27545-6525
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Country | US
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Telephone | 919-747-5210
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Fax | 919-747-5211
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Provider Business Mailing Address
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Address Line | 6602 KNIGHTDALE BLVD SUITE 102
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City | KNIGHTDALE
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State | NC
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Zip | 27545-6525
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Country | US
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Telephone | 919-747-5210
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Fax | 919-747-5211
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 42431
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License Number State | CO
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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 | 21409
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License Number State | NC
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