MEDICARE: JOHN KIM JOHNSON 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	207T00000X	Neurological Surgery Physician	12867	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00318488	OTHER	SC	RR MEDICARE
2	P00801293	OTHER	SC	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	576007863180	OTHER	SC	BCBS OF SC

General Provider Information

NPI Number	:	1508861345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN KIM JOHNSON M.D.

Provider Business Mailing Address
First Line	:	1 INDEPENDENCE PT
Second Line	:	SUITE 212
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4566
Country	:	US
Telephone Number	:	864-797-6044
Fax Number	:	864-797-6198

Provider Business Practice Location Address
First Line	:	200 PATEWOOD DR
Second Line	:	SUITE B260
City	:	GREENVILLE
State	:	SC
Zip	:	29615-3593
Country	:	US
Telephone Number	:	864-454-4600
Fax Number	:	864-464-4605

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	05/09/2011

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Directions to “ JOHN KIM JOHNSON M.D.” Practice Location

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