Evelyn Delois Johnson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

039602 Issued in GA

Practice address

1600 Gloucester St
Brunswick, GA 31520-7145

Phone

(912) 265-8080

Fax

(912) 265-8513

NPI assigned

Jan 5, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212969600000",
    "number": "1285781575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 GLOUCESTER ST",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315207145",
            "telephone_number": "912-265-8080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 GLOUCESTER ST",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315207145",
            "telephone_number": "912-265-8080",
            "fax_number": "912-265-8513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "EVELYN",
        "middle_name": "DELOIS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2008-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "039602",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME 60541",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00636028B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John E Imhoff MD PC
• John F. Ellenberg, M.D., P.C.
• John K Weaver, DMD PC
• Chadrika L Johnson, OWNER, CENTER DIRECT
• Deborah F Johnson, RN-BSN
• Jimmy Wallace Johnson Jr.
• Laura Johnson, PA-C
• Mallory Harris Johnson, CRNA
• Mark Robin Johnson, DDS
• Steven G Johnson, M.D.

• Pediatrics Physician in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; 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.