Individual
DR. WARREN CHARLES JOHNSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 MEDICAL PAVILION DR, SUITE 150, RAEFORD, NC 28376-0019
(910) 904-8025
(910) 615-9751
Mailing address
1638 OWEN DR, ATTN: MANAGED CARE PLANNING DEPT, FAYETTEVILLE, NC 28304-3424
(910) 904-8025
(910) 615-9751
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2014-02019
NC
208000000X
Pediatrics Physician
2000167444
MO
208000000X
Pediatrics Physician
Primary
2014-02019
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205099906
—
MO
Enumeration date
08/11/2005
Last updated
06/06/2016
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