Dwayne Johnson MD PSC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

28666 Issued in KY

Legal business name

DWAYNE JOHNSON MD PSC

Doing business as

Strathmoor Pediatrics

Practice address

2211 Meadow Dr
Louisville, KY 40218-1330

Phone

(502) 458-2577

Fax

(502) 454-0105

NPI assigned

Feb 27, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Dwayne Edward Johnson, M.D.

Title

President

Phone

(502) 458-2577

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Strathmoor Pediatrics Doing business as

Locations

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689701542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 MEADOW DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402181330",
            "telephone_number": "502-458-2577",
            "fax_number": "502-454-0105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 MEADOW DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402181330",
            "telephone_number": "502-458-2577",
            "fax_number": "502-454-0105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DWAYNE JOHNSON MD PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DWAYNE",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "502-458-2577",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "28666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6594322700",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Strathmoor Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jorden E. Duvall, LMT
• Rebecca Duvall, MA, CCC-SLP
• Sarah Marie Duvall, MSW, CSW
• Stuart Edward Duvall, RN
• Aleia Dvorak, CSW
• Unnu Enerelt Dwenger
• Amit J Dwivedi, MD
• Sunita A Dwivedi, MD
• Amy Dwyer, MD
• Colleen Dwyer, MD

• Pediatrics Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Pediatrics Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.