| Doctor Name: | DOUGLAS MARK JOHNSON |
| NPI Number: | 1811974553 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | 200501288 |
| Business Practice Address: | Medical Center Blvd Winston Salem, NC - 271570001 |
| Business Phone Number: | 3367162255 |
| Business Fax Number: | |
| Mailing Address: | 620 Summit Crossing Place, Suite 106 GASTONIA |
| State: | NC |
| Postal Code: | 280542189 |
| Phone Number: | 7048678021 |
| Fax Number: | 7048644606 |
| NPI Enumeration Date: | 12/23/2005 |
| NPI Last Update Date: | 09/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085B0100X |
| License Number: | 200501288 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Body Imaging |
| Taxonomy Definition: | A Radiology doctor of Osteopathy that specializes in Body Imaging. |