Individual
NICHOLAS BRADFORD JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3200 CHANNING WAY STE 206, IDAHO FALLS, ID 83404-7546
(208) 529-2230
(208) 453-6142
Mailing address
PO BOX 277381, ATLANTA, GA 30384-7381
(208) 529-2230
(208) 453-6142
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
01076429A
IN
208200000X
Plastic Surgery Physician
83999
GA
208200000X
Plastic Surgery Physician
Primary
M-14721
ID
2086S0122X
Plastic and Reconstructive Surgery Physician
M-14721
ID
Other
Enumeration date
07/01/2011
Last updated
03/25/2025
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