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Individual

DOUGLAS MARK JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
620 SUMMIT CROSSING PLACE, SUITE 106, GASTONIA, NC 28054-2189
(704) 867-8021
(704) 864-4606

Taxonomy

Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
200501288
NC
2085R0202X
Diagnostic Radiology Physician
Primary
2005-01288
NC
2085R0202X
Diagnostic Radiology Physician
200501288
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
5902558
NC
Enumeration date
12/23/2005
Last updated
09/22/2010
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