MEDICARE: DR. TERRY D JOHNSON MD

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	207Q00000X	Family Medicine Physician	7353	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00829107	OTHER	SC	RAILROAD MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	080075168	OTHER		RR MCR

General Provider Information

NPI Number	:	1730167651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY D JOHNSON MD

Provider Business Mailing Address
First Line	:	201 SIGMA DR
Second Line	:	STE 100
City	:	SUMMERVILLE
State	:	SC
Zip	:	29486-7715
Country	:	US
Telephone Number	:	843-793-5970
Fax Number	:	843-818-2187

Provider Business Practice Location Address
First Line	:	2550 ELMS CENTER RD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9844
Country	:	US
Telephone Number	:	843-302-8840
Fax Number	:	843-818-2188

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	12/04/2017

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