Active NPI
Emily Kathleen Johnson, M.D.
- Pediatrics Physician
- Summerville, SC
National Provider Identifier
1073653945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 38009
- Practice address
- 2016 1St Ave
Summerville, SC 29486-0408 - Phone
- (843) 873-4545
- Fax
- (843) 873-1561
- NPI assigned
- Feb 8, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 38009 | SC | Primary |
Addresses
Primary practice location
2016 1St Ave
Summerville, SC 29486-0408
Mailing address
704 N Shore Dr
Charleston, SC 29412-4216
Phone (502) 235-3114
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38009 | SC | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sweetgrass Pediatrics | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- North Charleston, SC
- NPI 1437168135
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466380800000",
"number": "1073653945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "704 N SHORE DR",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294124216",
"telephone_number": "502-235-3114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2016 1ST AVE",
"city": "SUMMERVILLE",
"state": "SC",
"postal_code": "294860408",
"telephone_number": "843-873-4545",
"fax_number": "843-873-1561"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "EMILY",
"middle_name": "KATHLEEN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-08",
"last_updated": "2016-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "SC",
"license": "38009",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Summerville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.