Individual
CHARLES H JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
830 AINSWORTH DRIVE, PRESCOTT, AZ 86301-1614
(928) 776-0325
(928) 776-0405
Mailing address
830 AINSWORTH DR, PRESCOTT, AZ 86301-1630
(928) 776-0325
(928) 776-0405
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
17178
AZ
207R00000X
Internal Medicine Physician
17178
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
282731
—
AZ
Enumeration date
01/20/2006
Last updated
04/11/2019
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