Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 2011-01906 | NC |
N | 207K00000X | Allergist & Immunologist | 967 | SC |
N | 207K00000X | Allergist & Immunologist | DO840 | AL |
NPI | 1124048079 |
---|---|
Provider Name | Douglas Thomas Johnston |
First Address | Charlotte, NC 28204-4398 |
Second Address | Charlotte, NC 28204-4398 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 25/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009671 | (05) | SC |
5920097 | (05) | NC |
I10980 | (02) | SC |