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1447256102

NPI Code Detail

MEDICARE: DR. SANDRA MARCHESE JOHNSON MD

MEDICARE: DR. SANDRA MARCHESE 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	207ND0101X	MOHS-Micrographic Surgery Physician	E1554	AR
2	207ND0900X	Dermatopathology Physician	E-1554	AR
3	207NI0002X	Clinical & Laboratory Dermatological Immunology Physician	E-1554	AR
4	207NP0225X	Pediatric Dermatology Physician	E1554	AR
5	207NS0135X	Procedural Dermatology Physician	E-1554	AR
6	207N00000X	Dermatology Physician	E-1554	AR

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	:	1447256102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA MARCHESE JOHNSON MD

Provider Business Mailing Address
First Line	:	5921 RILEY PARK DR
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-6103
Country	:	US
Telephone Number	:	479-420-1221
Fax Number	:

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	:	479-420-1221
Fax Number	:	479-646-0133

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	08/30/2023

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Directions to “ DR. SANDRA MARCHESE JOHNSON MD” Practice Location

Language	Start Address	Practice Location

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