Organization
PREMIER PEDIATRICS OF INDIANA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARISSE JOHNSON MD (SOLE PROPRIETOR)
(317) 345-3142
Entity
Organization
Contact information
Practice address
229 FLORENCE AVE STE 233, GRANGER, IN 46530-8048
(574) 855-4575
Mailing address
229 FLORENCE AVE STE 233, GRANGER, IN 46530-8048
(574) 855-4575
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
11/11/2020
Last updated
07/20/2021
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