Active NPI
Randall Divan Johnson, MD
- Surgery Physician
- Asheville, NC
National Provider Identifier
1912915562
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 21977
- Practice address
- 14 Medical Park Dr
Asheville, NC 28803-2493 - Phone
- (828) 252-3366
- Fax
- (828) 258-0891
- NPI assigned
- Aug 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 21977 | NC | Primary |
Addresses
Primary practice location
14 Medical Park Dr
Asheville, NC 28803-2493
Mailing address
14 Medical Park Dr
Asheville, NC 28803-2493
Phone (828) 252-3366
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8946475 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21977 | NC | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1912915562",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 MEDICAL PARK DR",
"city": "ASHEVILLE",
"state": "NC",
"postal_code": "288032493",
"telephone_number": "828-252-3366",
"fax_number": "828-258-0891"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14 MEDICAL PARK DR",
"city": "ASHEVILLE",
"state": "NC",
"postal_code": "288032493",
"telephone_number": "828-252-3366",
"fax_number": "828-258-0891"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "RANDALL",
"middle_name": "DIVAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NC",
"license": "21977",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8946475",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Asheville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.