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Organization
BROADWAY CLINIC INC
Active
Organization
BROADWAY CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTOINE DOUGLASS JOHNSON MD (FAMILY MEDICINE PHYICIAN CEO BROAWA)
(360) 538-7292
Entity
Organization
Contact information
Practice address
104 W 4TH ST, SUITE # 105, ABERDEEN, WA 98520-3932
(360) 538-7292
(360) 533-2566
Mailing address
PO BOX 149, ABERDEEN, WA 98520-0063
(360) 538-7292
(360) 533-2566
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
08/30/2006
Last updated
08/22/2020
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