Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0300X | Geriatric Medicine | 16534 | SC |
Y | 207RG0300X | Geriatric Medicine | 34364 | NC |
NPI | 1033122742 |
---|---|
Provider Name | Dr. Carlton David Johnson |
First Address | Asheville, NC 28803-2046 |
Second Address | Asheville, NC 28803-2046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 23/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
165341 | (05) | SC |
E91134 | (02) |