MEDICARE: DR. PAMELA ANN 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	208000000X	Pediatrics Physician	9401228	NC

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	:	1639142631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA ANN JOHNSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-384-1166
Fax Number	:	704-384-1181

Provider Business Practice Location Address
First Line	:	2701 STATESVILLE AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28206
Country	:	US
Telephone Number	:	980-302-8521
Fax Number	:	980-302-8525

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	03/23/2023

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