Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 39287 | NC |
NPI | 1033136551 |
---|---|
Provider Name | Dr. Carol Ann Johnston |
First Address | Jacksonville, NC 28546-7325 |
Second Address | Jacksonville, NC 28546-7325 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 23/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
46052 | BLUECROSS BLUESHIELD (01) | NC |
8946052 | (05) | NC |
E76859 | (02) |