MEDICARE: RONALD LEE JOHNSON SR. M.D.

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	10556	SC
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	10556	SC

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	:	1467487686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD LEE JOHNSON SR. M.D.

Provider Business Mailing Address
First Line	:	4100 MAIN ST
Second Line	:	SUITE 201
City	:	COLUMBIA
State	:	SC
Zip	:	29203-5800
Country	:	US
Telephone Number	:	803-786-0980
Fax Number	:	803-786-6452

Provider Business Practice Location Address
First Line	:	4100 MAIN ST
Second Line	:	SUITE 201
City	:	COLUMBIA
State	:	SC
Zip	:	29203-5800
Country	:	US
Telephone Number	:	803-786-0980
Fax Number	:	803-786-6452

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	10/01/2013

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