Individual
DR. CHARLES JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
554 KEILY STREET, JACKSONVILLE, FL 32212
(757) 953-7550
(757) 953-7560
Mailing address
554 KEILY STREET, BUREAU OF MEDICINE AND SURGERY, CENTRALIZED CREDENTIAL AND PRIVILEGING DIRECTORATE, JACKSONVILLE, FL 32212
(757) 953-7550
(757) 953-7560
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0101250181
VA
2085R0202X
Diagnostic Radiology Physician
89692
GA
2085R0202X
Diagnostic Radiology Physician
Primary
ME110710
FL
Other
Enumeration date
06/24/2010
Last updated
10/08/2025
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