Doctor Name: | CRYSTAL Y. JOHNSON |
NPI Number: | 1407804826 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 27811 |
Business Practice Address: | 2728 Sunset Blvd Ste 202 West Columbia, SC - 29169 |
Business Phone Number: | 8039367099 |
Business Fax Number: | 8037887384 |
Mailing Address: | 2728 Sunset Blvd, Ste 202 WEST COLUMBIA |
State: | SC |
Postal Code: | 29169 |
Phone Number: | 8039367099 |
Fax Number: | 8038654932 |
NPI Enumeration Date: | 05/05/2006 |
NPI Last Update Date: | 08/24/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 27811 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | SC |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |