Glen F Johnson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

00010366 Issued in NC

Practice address

524 Beaumont Rd
Fayetteville, NC 28304-4443

Phone

(800) 476-8646

NPI assigned

Jun 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

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bladen County Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Elizabethtown, NC
  • NPI 1629260211
  NPD (past)
• Cumberland County Hospital System Inc

  • Diagnostic Radiology Physician
  • Fayetteville, NC
  • NPI 1962299743
  NPD (past)

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202860800000",
    "number": "1619971561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1070",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282011070",
            "telephone_number": "800-476-8646",
            "fax_number": "919-382-3210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 BEAUMONT RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044443",
            "telephone_number": "800-476-8646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "GLEN",
        "middle_name": "F",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2008-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "00010366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00390009",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Curtis Johnson, PA-C
• Cynthia Patrice Johnson, LCMHC, NCC
• Deangelo Latrall Johnson, RBT
• Delores Lorraine Johnson, MD
• Elizabeth Johnson
• Gloria D Johnson, LCSW-A
• Helen Delores Johnson
• Jacqulyn Johnson
• Jalen Johnson
• James Erwin Johnson, M.D.

• Physician Assistant in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.