MEDICARE: DWAYNE JOHNSON MD PSC

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	28666	KY

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	:	1689701542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DWAYNE JOHNSON MD PSC

Provider Business Mailing Address
First Line	:	2211 MEADOW DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-1330
Country	:	US
Telephone Number	:	502-458-2577
Fax Number	:	502-454-0105

Provider Business Practice Location Address
First Line	:	2211 MEADOW DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-1330
Country	:	US
Telephone Number	:	502-458-2577
Fax Number	:	502-454-0105

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DWAYNE EDWARD JOHNSON
Credential	:	M.D.
Telephone Number	:	502-458-2577

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

1407210289 — ANTHONY DISTLER DMD
Practice Location Address:

2221 MEADOW DR
LOUISVILLE, KY
40218-1330

Practice Phone: 502-523-2433
Practice Fax:

1710725809 — DISTLER FAMILY DENTISTRY PLLC
Practice Location Address:

2221 MEADOW DR
LOUISVILLE, KY
40218-1330

Practice Phone: 502-458-7744
Practice Fax: 502-458-7707

1568313138 — CULTIVATING HEARTS YOUTH HOME
Practice Location Address:

3703 TAYLORSVILLE RD STE 104
LOUISVILLE, KY
40220-1330

Practice Phone: 502-640-8725
Practice Fax:

1326075466 — MR. JACK DAVIS SELLS DC
Practice Location Address:

3703 TAYLORSVILLE RD STE 105
LOUISVILLE, KY
40220-1330

Practice Phone: 502-558-0099
Practice Fax: 502-709-5414

1750871638 — CATHERINE M WARD LCSW
Practice Location Address:

3703 TAYLORSVILLE RD STE 102
LOUISVILLE, KY
40220-1330

Practice Phone: 502-438-8685
Practice Fax:

1427540160 — KRISTINA MICHELLE WATERS LCSW, LMFT
Practice Location Address:

1330 ELLISON AVE
LOUISVILLE, KY
40204-1657

Practice Phone: 502-694-9488
Practice Fax:

Directions to “DWAYNE JOHNSON MD PSC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.