Charles E. Johnson II, M.D.
Individual provider Active NPI Pediatrics Physician · South Williamson, KY
NPI 1659309367 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1659309367
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 25945 (KY)
- Practice address
- 306 Hospital Dr
South Williamson, KY 41503-4095 - Phone
- (606) 237-1766
- Fax
- (606) 237-1790
- NPI assigned
- Jun 29, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25945 | KY | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Appalachian Regional Healthcare, Inc. | Pediatrics | Past | Accepting new patients |
| Appalachian Regional Healthcare, Inc. | Past | Accepting new patients |
Interoperability endpoints
- charlesjohnson@arh.medalliesdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 25945 | KY | Yes |
Addresses
Primary practice location
306 Hospital Dr
South Williamson, KY 41503-4095
Mailing address
306 Hospital Dr
South Williamson, KY 41503-4095
Phone (606) 237-1766
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 65920951 | Medicaid | KY | |
| 0106847000 | Medicaid | WV |
Other providers in South Williamson, KY
- Gary L Hopkins
- Imtiaz Hussain
- Jenq-Sheng Liu M.D. Inc
- Jenq-Shengliu M.D. Inc.
- Bryna Gene Jewell
- Justin Jones
- Aaron Jeffery Justice
- Karnes Medical Services LLC
- Betty Joan Karnes
- Kentucky CVS Pharmacy, L.L.C.
All providers in South Williamson, KY · Pediatrics Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.