Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 200100712 | NC |
NPI | 1285636076 |
---|---|
Provider Name | Charles S Johnson |
First Address | Gastonia, NC 28054-7488 |
Second Address | Hickory, NC 28602-4230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 23/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89136XW | (05) | NC |
H39029 | (02) | NC |