Versan Johnson, M.D.

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

ME130663 Issued in FL

Practice address

761 Stirling Center PL
Lake Mary, FL 32746-5700

Phone

(407) 732-7682

Fax

(407) 915-6843

NPI assigned

Apr 5, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Versan Jackson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1301961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1447549985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1740 W TAYLOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606127232",
            "telephone_number": "312-996-4021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "761 STIRLING CENTER PL",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327465700",
            "telephone_number": "407-732-7682",
            "fax_number": "407-915-6843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "VERSAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-05",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "FL",
            "license": "ME130663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VERSAN",
            "last_name": "JACKSON",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Laila Johnson
• Linda Kay Johnson, BSW
• Reynold Johnson Jr.
• Sheryl Lynn Johnson, FNLP
• Tashada Johnson
• Crystal Johnston Garcia, MSN, APRN, FNP-BC
• Dean Livingston Johnston, M.D.
• Kate Jones
• Mariah Deramo Jones, LCSW
• Natassia T Jones, AGACNP-BC

• Interventional Pain Medicine Physician in Lake Mary, FL
• Providers in Lake Mary, FL by specialty
• Interventional Pain Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.