Carol A Johnson, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4080 Issued in AZ

Practice address

410 N Malacate St
Ajo, AZ 85321-2254

Phone

(520) 387-5651

Fax

(520) 387-6036

NPI assigned

Mar 23, 2006

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Female

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

Doctor of Osteopathy, Doctor of Medicine

Practice roles

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

• Mid-Hudson Family Health Institute

  • Family Medicine Physician
  • New Paltz, NY
  • NPI 1326093642
  NPD (past)

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1811957145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 N MALACATE ST",
            "city": "AJO",
            "state": "AZ",
            "postal_code": "853212254",
            "telephone_number": "520-387-5651",
            "fax_number": "520-387-6036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 N MALACATE ST",
            "city": "AJO",
            "state": "AZ",
            "postal_code": "853212254",
            "telephone_number": "520-387-5651",
            "fax_number": "520-387-6036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "CAROL",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-23",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "4080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "861949",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kauri Duvall
• Susan Guinn-Lahm, LPC
• Gorky Herrera, M.D.
• Thomas Eugene Horst, MD
• Donald T Innes, P.A.
• Brian David Jones, MPT
• Mary Catherine Kehl, PA C
• Jeffrey R Lavoy, M.D.
• Lifetorch Recovery Center & Wellness LLC
• Lifetorch Recovery Center & Wellness LLC

• Family Medicine Physician in Ajo, AZ
• Providers in Ajo, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.