MEDICARE: DELORES LORRAINE JOHNSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	200400525	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043271778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELORES LORRAINE JOHNSON MD

Provider Business Mailing Address
First Line	:	2135 VALLEYGATE DRIVE SUITE 101
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304
Country	:	US
Telephone Number	:	910-920-1858
Fax Number	:	910-339-9040

Provider Business Practice Location Address
First Line	:	2135 VALLEYGATE DRIVE SUITE 101
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-4415
Country	:	US
Telephone Number	:	910-920-1858
Fax Number	:	910-339-9040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	10/23/2025

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