Harold Timothy Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9101157 Issued in FL

Practice address

1005 Mar Walt Dr
Family Medicine Department
Fort Walton Beach, FL 32547-6707

Phone

(850) 863-6600

Fax

(850) 862-0977

NPI assigned

Dec 14, 2005

Last updated

Jan 17, 2017By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484611200000",
    "number": "1336124098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 MAR WALT DR",
            "address_2": "FAMILY MEDICINE DEPARTMENT",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476707",
            "telephone_number": "850-863-6600",
            "fax_number": "850-862-0977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 MAR WALT DR",
            "address_2": "FAMILY MEDICINE DEPARTMENT",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476707",
            "telephone_number": "850-863-6600",
            "fax_number": "850-862-0977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "HAROLD",
        "middle_name": "TIMOTHY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-14",
        "last_updated": "2017-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9101157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290698800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSFL",
            "identifier": "Y0CH5",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John S Chomer DC MD PC
• John S Kovar DC PA
• Cierra Johnson
• Elizabeth Anne Johnson
• Eva Johnson
• Jaime Michelle Johnson, LPN
• Katrina R Johnson, M.S., CCC-SLP
• Kiera Johnson
• Matthew S Johnson, MD
• Melissa Sue Johnson, BASLPA

• Physician Assistant in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2017; 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.