Olga Khodakova Johnson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2013-00053 Issued in NC

Practice address

1606 Morganton Rd
Fayetteville, NC 28305-4738

Phone

(910) 484-3121

Fax

(910) 221-2036

NPI assigned

Jun 15, 2009

Last updated

Feb 4, 2013By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Fayetteville Children's Clinic, P.a.

  • Pediatrics Physician
  • Fayetteville, NC
  • NPI 1730270448
  NPD (past)

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

{
    "created_epoch": "1245024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359936000000",
    "number": "1821225046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1606 MORGANTON RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283054738",
            "telephone_number": "910-484-3121",
            "fax_number": "910-221-2036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1606 MORGANTON RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283054738",
            "telephone_number": "910-484-3121",
            "fax_number": "910-221-2036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "OLGA",
        "middle_name": "KHODAKOVA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-15",
        "last_updated": "2013-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "8278611-1205",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2013-00053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marilyn Little Johnson, CCC-SLP
• Marina Gordula Johnson, LCSW
• Marva E Johnson, LPC
• Nichole Lushawn Johnson, LCSW, LCAS
• Octavia Armond Johnson, RBT
• Oliver James Johnson, PH.D., LCSW
• Patricia Evon Johnson
• Precious Lanikka Shardea Johnson
• Raven Johnson
• Rawny Jo Johnson

• Pediatrics Physician in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2013; 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.