Individual
KENNETH LEE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
34 HEALTHPARK WAY STE 100D, CLAYTON, NC 27520-4497
(919) 585-8850
(919) 585-8869
Mailing address
2000 PERIMETER PARK DR STE 200, MORRISVILLE, NC 27560-8442
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
2009-01364
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5912563
—
NC
Enumeration date
06/13/2006
Last updated
05/10/2021
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