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General NPI Number Information
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NPI Number | 1841226867
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Entity Type | Individual
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Provider Name | GARY D JOHNSON MD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 900 DOUGLAS PIKE
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City | SMITHFIELD
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State | RI
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Zip | 02917-1879
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Country | US
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Telephone | 401-618-5507
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Fax | 866-228-6713
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Provider Business Mailing Address
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Address Line | 15 LA SALLE SQ
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City | PROVIDENCE
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State | RI
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Zip | 02903-1814
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Country | US
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Telephone | 401-444-6779
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Fax | 401-444-6912
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD08010
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License Number State | RI
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