NPIMap

Organization Active NPI

Johnny L. McKinnon, Jr., D.D.S., P.a.

  • General Practice Dentistry
  • Mount Gilead, NC
National Provider Identifier
1376712075
Registry record updated Feb 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6063 Issued in NC
Legal business name
JOHNNY L. MCKINNON, JR., D.D.S., P.A.
Practice address
407 North Main Street
Mt. Gilead, NC 27306-0022
Phone
(910) 439-9744
Fax
(910) 439-4113
NPI assigned
Feb 27, 2008
Last updated
Feb 27, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2008

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

Authorized official

Name
Dr. Johnny L. McKinnon Jr., D.D.S.NPI 1124129341
Title
President/Dentist
Phone
(910) 439-9744

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 6063 NC Primary

Addresses

Primary practice location

407 North Main Street
Mt. Gilead, NC 27306-0022

Mailing address

PO Box 22
407 North Main Street
Mount Gilead, NC 27306-0022
Phone (910) 439-9744

Other identifiers 1

IdentifierTypeStateIssuer
8995803MedicaidNC

National Provider Directory

National Provider Directory

Locations

407 N Main St
Mount Gilead, NC 27306
Phone (910) 439-9744

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1204070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204070400000",
    "number": "1376712075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22",
            "address_2": "407 NORTH MAIN STREET",
            "city": "MOUNT GILEAD",
            "state": "NC",
            "postal_code": "273060022",
            "telephone_number": "910-439-9744",
            "fax_number": "910-439-4113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 NORTH MAIN STREET",
            "city": "MT. GILEAD",
            "state": "NC",
            "postal_code": "273060022",
            "telephone_number": "910-439-9744",
            "fax_number": "910-439-4113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNNY L. MCKINNON, JR., D.D.S., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-27",
        "last_updated": "2008-02-27",
        "status": "A",
        "authorized_official_last_name": "MCKINNON",
        "authorized_official_first_name": "JOHNNY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT/DENTIST",
        "authorized_official_telephone_number": "910-439-9744",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "6063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8995803",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Gilead, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 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.