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General NPI Number Information
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NPI Number | 1801454244
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Entity Type | Individual
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Provider Name | OLIVIA JOHNSON MD
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Gender | Female
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Dates
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Enumeration Date | 05/31/2019
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 864 BLACK CREEK RD
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City | FOUR OAKS
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State | NC
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Zip | 27524-8314
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Country | US
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Telephone | 919-936-3148
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Fax | 919-936-2900
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Provider Business Mailing Address
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Address Line | 864 BLACK CREEK RD
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City | FOUR OAKS
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State | NC
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Zip | 27524-8314
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Country | US
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Telephone | 919-936-3148
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Fax | 919-936-2900
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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 | 94-09933
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 202302334
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License Number State | NC
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