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NPI Code Detail

MEDICARE: SYDNEY JOHNSON

MEDICARE: SYDNEY JOHNSON
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 ProgramSC

General Provider Information

NPI Number : 1447118310
Entity Type Code : Individual
Provider Name (Legal Business Name) : SYDNEY JOHNSON
Provider Business Mailing Address
First Line : 201 FRYSTON LN
Second Line :
City : BLYTHEWOOD
State : SC
Zip : 29016-9237
Country : US
Telephone Number : 609-313-1048
Fax Number :
Provider Business Practice Location Address
First Line : 4500 FORT JACKSON BLVD STE 110
Second Line :
City : COLUMBIA
State : SC
Zip : 29209-1134
Country : US
Telephone Number : 803-800-1868
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2026
Last Update Date : 01/12/2026

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Directions to “ SYDNEY JOHNSON ” Practice Location

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