Individual
RANDALL DIVAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14 MEDICAL PARK DR, ASHEVILLE, NC 28803-2493
(828) 252-3366
(828) 258-0891
Mailing address
14 MEDICAL PARK DR, ASHEVILLE, NC 28803-2493
(828) 252-3366
(828) 258-0891
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
21977
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8946475
—
NC
Enumeration date
08/03/2006
Last updated
07/08/2007
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