Eddie D. Johnson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

013614 Issued in LA

Practice address

2508 Bert Kouns Loop
Suite 102
Shreveport, LA 71118-3133

Phone

(318) 671-1291

Fax

(318) 688-6014

NPI assigned

Nov 9, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198800000000",
    "number": "1275514978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS LOOP",
            "address_2": "SUITE 102",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183133",
            "telephone_number": "318-671-1291",
            "fax_number": "318-688-6014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS LOOP",
            "address_2": "SUITE 102",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183133",
            "telephone_number": "318-671-1291",
            "fax_number": "318-688-6014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "EDDIE",
        "middle_name": "D.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-09",
        "last_updated": "2007-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "013614",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1180289",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deastra Lyshell Johnson
• Deborah Sue Johnson, M.C.D., CCC-SLP
• Dia M. Johnson, APRN, WHNP-BC, FNP-C
• Donald Ray Johnson II
• Donnyshia Johnson
• Eddie Glen Johnson III, M.D.
• Ema-Chanel Johnson, MSN, APRN, FNP-C
• Ethel Johnson
• Felisa Johnson Johnson, COTA
• Frederica Johnson

• Family Medicine Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Family Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.