Individual
DR. CARL M JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2601 KENTUCKY AVE, STE 300, PADUCAH, KY 42003-3826
(270) 443-5564
(270) 443-5549
Mailing address
2601 KENTUCKY AVE, STE 306, PADUCAH, KY 42003-3817
(270) 415-7653
(270) 575-8359
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
24921
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64249212
—
KY
Enumeration date
06/23/2005
Last updated
12/04/2020
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