MEDICARE: LINDSAY MARIE JOHNSON PA

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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1972988590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY MARIE JOHNSON PA

Provider Business Mailing Address
First Line	:	199 VILLAGE CENTER BLVD STE 200
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-3589
Country	:	US
Telephone Number	:	843-738-0500
Fax Number	:	843-738-0505

Provider Business Practice Location Address
First Line	:	199 VILLAGE CENTER BLVD STE 200
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-3589
Country	:	US
Telephone Number	:	843-738-0500
Fax Number	:

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

Provider Enumeration Date	:	07/24/2015
Last Update Date	:	07/12/2021

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Directions to “ LINDSAY MARIE JOHNSON PA” Practice Location

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