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NPI Code Detail

MEDICARE: MR. JOSHUA BEATY JOHNSON PA-C

MEDICARE:  MR. JOSHUA BEATY 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
1363AM0700XMedical Physician AssistantP-T1547AR

General Provider Information

NPI Number : 1780055178
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSHUA BEATY JOHNSON PA-C
Provider Business Mailing Address
First Line : 4617 E MCCAIN BLVD
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72117-2904
Country : US
Telephone Number : 501-945-0680
Fax Number :
Provider Business Practice Location Address
First Line : 4617 E MCCAIN BLVD
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72117-2904
Country : US
Telephone Number : 501-945-0680
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2015
Last Update Date : 10/12/2015

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Directions to “ MR. JOSHUA BEATY JOHNSON PA-C” Practice Location

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