Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2015-00949 | NC |
Y | 207Q00000X | Family Doctor | 2015-00949 | NC |
NPI | 1063708378 |
---|---|
Provider Name | Megan P. Johnson |
First Address | Graham, NC 27253-3022 |
Second Address | Graham, NC 27253-3022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2011 |
Last Update Date | 28/09/2021 |