Individual
CHARLOTTE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
382 N 120TH AVE, HOLLAND, MI 49424-2169
(616) 396-6516
(616) 396-2513
Mailing address
382 N 120TH AVE, HOLLAND, MI 49424-2169
(616) 396-6516
(616) 396-2513
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301062100
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0410445
BCBS NUMBER
MI
05
—
3319110
—
MI
Enumeration date
11/09/2006
Last updated
01/12/2011
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