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NPI Code Detail

MEDICARE: JOHNSON DERMATOLOGY CLINIC PLLC

MEDICARE: JOHNSON DERMATOLOGY CLINIC PLLC
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
1207N00000XDermatology Physician
2207ND0101XMOHS-Micrographic Surgery Physician
3207ND0900XDermatopathology Physician
4207NI0002XClinical & Laboratory Dermatological Immunology Physician
5207NP0225XPediatric Dermatology Physician
6207NS0135XProcedural Dermatology Physician
7207N00000XDermatology PhysicianMC-2480AR

General Provider Information

NPI Number : 1437110962
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOHNSON DERMATOLOGY CLINIC PLLC
Provider Business Mailing Address
First Line : 5921 RILEY PARK DR
Second Line :
City : FORT SMITH
State : AR
Zip : 72916-6103
Country : US
Telephone Number : 479-649-3376
Fax Number : 479-646-0133
Provider Business Practice Location Address
First Line : 5921 RILEY PARK DR
Second Line :
City : FORT SMITH
State : AR
Zip : 72916-6103
Country : US
Telephone Number : 479-649-3376
Fax Number : 479-646-0133
Authorized Official
Title or Position : GENERAL MANAGER
Name : DR. SANDRA MARCHESE JOHNSON
Credential : MD
Telephone Number : 479-649-3376
Provider Enumeration Date : 04/02/2006
Last Update Date : 08/31/2023

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