Individual
MR. EARLIE T JOHNSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2580 HENDERSON DR, JACKSONVILLE, NC 28546-5252
(910) 346-1188
(910) 346-1275
Mailing address
305 COUNTRY CLUB DR, JACKSONVILLE, NC 28546-7420
(910) 347-1673
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
31729
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0154H
BCBS
NC
05
—
890154H
—
NC
Enumeration date
03/31/2006
Last updated
12/19/2012
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