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NPI Code Detail

MEDICARE: DOUGLAS ELI JOHNSON PHD

MEDICARE: DOUGLAS ELI JOHNSON PHD
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1285581025
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS ELI JOHNSON PHD
Provider Business Mailing Address
First Line : 1576 RABON FARMS LN
Second Line :
City : COLUMBIA
State : SC
Zip : 29223-5877
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6311 GARNERS FERRY RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29209-1445
Country : US
Telephone Number : 803-216-3625
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2026
Last Update Date : 03/11/2026

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