MEDICARE: KENNETH LEE 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	207R00000X	Internal Medicine Physician	9801319	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110208101	OTHER		RAILROAD MEDICARE

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	:	1457336760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH LEE JOHNSON MD

Provider Business Mailing Address
First Line	:	701 DOCTORS DR
Second Line	:	SUITE N
City	:	KINSTON
State	:	NC
Zip	:	28501-1584
Country	:	US
Telephone Number	:	252-559-2200
Fax Number	:	252-522-9778

Provider Business Practice Location Address
First Line	:	701 DOCTORS DR
Second Line	:	SUITE N
City	:	KINSTON
State	:	NC
Zip	:	28501-1584
Country	:	US
Telephone Number	:	252-559-2200
Fax Number	:	252-522-9778

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

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	01/10/2022

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