Active NPI
Ada Johnson
- Exclusive Provider Organization
- Yadkinville, NC
National Provider Identifier
1013239151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Exclusive Provider Organization
- License
- 2883
- Practice address
- 903 W Main St
Yadkinville, NC 27055-7807 - Phone
- (336) 463-5510
- NPI assigned
- Feb 16, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Exclusive Provider Organization | 302F00000X | 2883 | NC | Primary |
Addresses
Primary practice location
903 W Main St
Yadkinville, NC 27055-7807
Mailing address
8045 Peak Rd
Clemmons, NC 27012-9789
Phone (336) 463-5510
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2883 | NC | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1266278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266278400000",
"number": "1013239151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8045 PEAK RD",
"city": "CLEMMONS",
"state": "NC",
"postal_code": "270129789",
"telephone_number": "336-463-5510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "903 W MAIN ST",
"city": "YADKINVILLE",
"state": "NC",
"postal_code": "270557807",
"telephone_number": "336-463-5510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "ADA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-02-16",
"last_updated": "2010-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "302F00000X",
"taxonomy_group": "",
"desc": "Exclusive Provider Organization",
"state": "NC",
"license": "2883",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yadkinville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.