Johnson Medical Clinic

Organization Active NPI Adult Medicine Physician · Algoma, WI

NPI 1962623280 · NPPES record last updated Mar 7, 2023

Key facts

NPI
1962623280
Entity type
Organization (NPI type 2)
Primary specialty
Adult Medicine Physician 207QA0505X
Legal business name
JOHNSON MEDICAL CLINIC
Practice address
N8434 County Rd S
Algoma, WI 54201-9515
Phone
(920) 487-5635
NPI assigned
May 2, 2007
Organization subpart
No

Authorized official

Name
Dr. Carla A Johnson, DO
Title
Owner and Sole Physician
Phone
(920) 487-5635

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP
207QA0505X Yes

Addresses

Primary practice location

N8434 County Rd S
Algoma, WI 54201-9515

Mailing address

N8434 County Rd S
Algoma, WI 54201-9515
Phone (920) 487-5635

Other identifiers

IdentifierTypeStateIssuer
HO35675OtherWIWISCONSIN CORPORATE NUMBE
30094500MedicaidWI

Other providers in Algoma, WI

All providers in Algoma, WI · Adult Medicine Physician in Wisconsin

Sources for this page

Verify at the official NPI Registry.