Organization
CONWAY INTERNISTS, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES W. JOHNSON JR. M.D. (MEDICAL DOCTOR)
(843) 347-7227
Entity
Organization
Contact information
Practice address
8002 MYRTLE TRACE DR., CONWAY, SC 29526
(843) 347-7227
Mailing address
8002 MYRTLE TRACE DR., CONWAY, SC 29526
(843) 347-7227
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4459
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1323
MEDICARE PTAN
SC
05
—
PA7901
—
SC
Enumeration date
10/17/2006
Last updated
11/18/2009
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