Willie Johnson, GM

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

207683 Issued in FL

Practice address

108 Julie LN
Auburndale, FL 33823-2335

Phone

(863) 269-8897

NPI assigned

Sep 9, 2022

Last updated

Sep 9, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1662681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662681600000",
    "number": "1801517651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23781 HWY 27 # 226",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338597802",
            "telephone_number": "863-269-8897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 JULIE LN",
            "city": "AUBURNDALE",
            "state": "FL",
            "postal_code": "338232335",
            "telephone_number": "863-269-8897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "WILLIE",
        "credential": "GM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-09",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "FL",
            "license": "207693",
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "FL",
            "license": "207683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Customized Equipment (DME) in Auburndale, FL
• Providers in Auburndale, FL by specialty
• Customized Equipment (DME) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 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.