Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 2015-00508 | NC |
NPI | 1003182015 |
---|---|
Provider Name | Dr. Soren Morgan Johnson |
First Address | Charlotte, NC 28260-0447 |
Second Address | Winston Salem, NC 27106-4966 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2012 |
Last Update Date | 28/01/2022 |