Basic Information
| Provider Information | |||||||||
| NPI: | 1730151481 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON-WALL | ||||||||
| FirstName: | HELEN | ||||||||
| MiddleName: | NICHOLE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 INDEPENDENCE PT STE 212 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296154536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647976308 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 301 MEMORIAL DR STE F | ||||||||
| Address2: | |||||||||
| City: | SENECA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296729445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648857758 | ||||||||
| FaxNumber: | 8648857867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 06/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 00351 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 60690598 | WA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 00351 | NC | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 82129 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.