Individual
JOHN KIM JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 PATEWOOD DR, SUITE B260, GREENVILLE, SC 29615-3593
(864) 454-4600
(864) 464-4605
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4566
(864) 797-6044
(864) 797-6198
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
12867
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128677
—
SC
01
—
576007863180
BCBS OF SC
SC
01
—
P00318488
RR MEDICARE
SC
01
—
P00801293
RR MEDICARE
SC
Enumeration date
06/17/2005
Last updated
05/09/2011
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