Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 2017-01066 | NC |
N | 207PP0204X | Pediatric Emergency Physician | 2017-01066 | NC |
NPI | 1124346390 |
---|---|
Provider Name | Adam Barrett Johnson |
First Address | Aurora, CO 80042-0429 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2010 |
Last Update Date | 17/03/2018 |