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NPI Code Detail

MEDICARE: DR. BENJAMIN DAWSEY JOHNSON PSY.D.

MEDICARE: DR. BENJAMIN DAWSEY JOHNSON PSY.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
1103T00000XPsychologist2976NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22200253OTHERNCCIGNA
3E4168-B0775OTHERNCMEDCOST

General Provider Information

NPI Number : 1972599934
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BENJAMIN DAWSEY JOHNSON PSY.D.
Provider Business Mailing Address
First Line : PO BOX 4003
Second Line :
City : GASTONIA
State : NC
Zip : 28054-0020
Country : US
Telephone Number : 704-865-3525
Fax Number : 704-865-3520
Provider Business Practice Location Address
First Line : 175 W FRANKLIN BLVD
Second Line :
City : GASTONIA
State : NC
Zip : 28052-4145
Country : US
Telephone Number : 704-865-3525
Fax Number : 704-865-3520
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2005
Last Update Date : 04/05/2022

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