MEDICARE: DR. KAREN EVANGELINE JOHNSON DDS, MHS

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	1223P0300X	Periodontics	11759	MD
2	1223P0300X	Periodontics	3116/PERIO 470	SC

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	:	1114921491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN EVANGELINE JOHNSON DDS, MHS

Provider Business Mailing Address
First Line	:	PO BOX 25731
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29224-5731
Country	:	US
Telephone Number	:	803-606-9011
Fax Number	:	803-630-1529

Provider Business Practice Location Address
First Line	:	2757 LAUREL ST STE 1
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2037
Country	:	US
Telephone Number	:	803-606-9011
Fax Number	:	803-630-1529

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	10/10/2023

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