MEDICARE: ROBERT EDWARD JOHNSON PA-C

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	363A00000X	Physician Assistant	9102838	FL
2	363A00000X	Physician Assistant	PA 9102838	FL
3	363AM0700X	Medical Physician Assistant	005331	GA
4	363AM0700X	Medical Physician Assistant	0010-02065	NC

General Provider Information

NPI Number	:	1609969674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT EDWARD JOHNSON PA-C

Provider Business Mailing Address
First Line	:	308 PRALEY ST NW
Second Line	:
City	:	VALDESE
State	:	NC
Zip	:	28690-2328
Country	:	US
Telephone Number	:	321-297-7115
Fax Number	:

Provider Business Practice Location Address
First Line	:	2280 US HIGHWAY 70 SE
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28602-5164
Country	:	US
Telephone Number	:	828-267-1201
Fax Number	:

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/28/2025

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