Basic Information
Provider Information
NPI: 1952352494
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOHNSON
FirstName: WILLIAM
MiddleName: PAUL
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 INDEPENDENCE PT
Address2: SUITE 212
City: GREENVILLE
State: SC
PostalCode: 296154545
CountryCode: US
TelephoneNumber: 8647976044
FaxNumber:  
Practice Location
Address1: 701 GROVE RD
Address2: 5TH FLOOR
City: GREENVILLE
State: SC
PostalCode: 296055611
CountryCode: US
TelephoneNumber: 8644554411
FaxNumber: 8644555008
Other Information
ProviderEnumerationDate: 05/12/2006
LastUpdateDate: 05/14/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X26434SCN Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000X26434SCY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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