Kenneth Allan Johnson, M.D.

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

037577 Issued in GA

Practice address

1601 Fair Rd
Suite 300
Statesboro, GA 30458-1698

Phone

(912) 871-6742

Fax

(912) 871-2563

NPI assigned

Aug 10, 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

Enrolled in NH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Catholic Medical Center

  • Vascular Surgery Physician
  • Manchester, NH
  • NPI 1235370057
  Medicare reassignment NPD
• Catholic Medical Center

  • Anesthesiology Physician
  • Manchester, NH
  • NPI 1003692112
  NPD
• Mousam Valley Orthopaedics PA

  • Orthopaedic Surgery Physician
  • Sanford, ME
  • NPI 1043374044
  NPD (past)
• The Medical Group Department of Goodall Hospital

  • Family Medicine Physician
  • Kennebunk, ME
  • NPI 1356356869
  NPD (past)

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404691200000",
    "number": "1790786820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 OAK RIDGE DR",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304589135",
            "telephone_number": "912-871-6742",
            "fax_number": "912-871-2563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 FAIR RD",
            "address_2": "SUITE 300",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304581698",
            "telephone_number": "912-871-6742",
            "fax_number": "912-871-2563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KENNETH",
        "middle_name": "ALLAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2014-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "GA",
            "license": "037577",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00572041A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aaron Johnson
• Cameron U Johnson
• Hannah Johnson
• Julie Johnson, APRN
• Katlyn D Johnson, CLC
• Kenneth W. Johnson, M.S., LPC
• Leslie Martin Johnson, M.S, CCC-SLP
• Ricky Brandon Johnson, FNP-C
• Tyteyana Johnson
• Koree Jacobs Joiner, FNP-C

• Orthopaedic Surgery Physician in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Orthopaedic Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.