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Individual

DR. ROBERT DUREN JOHNSON JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
672 HIGHWAY 9 W, BENNETTSVILLE, SC 29512-2130
(843) 479-2402
(843) 479-6609
Mailing address
2643 GREAT FALLS HWY, LANCASTER, SC 29720-7168
(803) 286-1586
(803) 313-3283

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
8389
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0120X
NC BCBS GROUP NUMBER
NC
05
083894
SC
01
30048
NC STATE LICENSE NUMBER
NC
01
4469
MEDICARE GROUP NUMBER
SC
01
8389
SC MEDICAL LICENSE NUMBER
SC
01
GP0789
SC MEDICAID GROUP NUMBER
SC
Enumeration date
03/01/2006
Last updated
03/07/2023
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