Organization
BRIAN A JOHNSON MD PC
Active
Other names
BRIAN A JOHNSON MD
Organization subpart
No
Provider details
NPI number
Authorized official
DIRENDIA SHACKELFORD (MANAGED CARE SPECIALIST)
(800) 654-0889
Entity
Organization
Contact information
Practice address
613 TERRACE DR, WINAMAC, IN 46996-1111
(574) 946-6644
Mailing address
613 TERRACE DR, WINAMAC, IN 46996-1111
(574) 946-6644
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
5003424A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100210710
—
IN
01
—
1535561
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/23/2006
Last updated
06/20/2008
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