Eddie Glen Johnson III, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

013312 Issued in LA

Practice address

7330 Fern Ave Ste 1103
Shreveport, LA 71105-4989

Phone

(318) 798-0635

NPI assigned

Nov 1, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

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

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

{
    "created_epoch": "1257033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257033600000",
    "number": "1962738500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 GRAYSON CIR",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711128605",
            "telephone_number": "318-458-2756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7330 FERN AVE STE 1103",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711054989",
            "telephone_number": "318-798-0635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "EDDIE",
        "middle_name": "GLEN",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-11-01",
        "last_updated": "2009-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "LA",
            "license": "013312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Sue Johnson, M.C.D., CCC-SLP
• Dia M. Johnson, APRN, WHNP-BC, FNP-C
• Donald Ray Johnson II
• Donnyshia Johnson
• Eddie D. Johnson, MD
• Ema-Chanel Johnson, MSN, APRN, FNP-C
• Ethel Johnson
• Felisa Johnson Johnson, COTA
• Frederica Johnson
• Gladys Johnson

• General Practice Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• General Practice Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2009; 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.