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NPI Code Detail

MEDICARE: TABETHA MARIE JOHNSON PA

MEDICARE: TABETHA MARIE JOHNSON PA
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
1363A00000XPhysician Assistant1217973

General Provider Information

NPI Number : 1598629990
Entity Type Code : Individual
Provider Name (Legal Business Name) : TABETHA MARIE JOHNSON PA
Provider Business Mailing Address
First Line : 6884 UPPINGHAM RD
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28306-2510
Country : US
Telephone Number : 704-446-5185
Fax Number :
Provider Business Practice Location Address
First Line : 1000 BLYTHE BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28203-5812
Country : US
Telephone Number : 704-446-5185
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2025
Last Update Date : 12/11/2025

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Directions to “ TABETHA MARIE JOHNSON PA” Practice Location

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