1346546512 NPI number — DR. OLAF KENNETH JOHNSON JR. M.D.

Table of content: DR. OLAF KENNETH JOHNSON JR. M.D. (NPI 1346546512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346546512 NPI number — DR. OLAF KENNETH JOHNSON JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
OLAF
Provider Middle Name:
KENNETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346546512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 70 ST JAMES PARISH CHILOMONI
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLANTYRE
Provider Business Mailing Address State Name:
SOUTHERN PROVINCE
Provider Business Mailing Address Postal Code:
CENTRAL AFRICA
Provider Business Mailing Address Country Code:
MW
Provider Business Mailing Address Telephone Number:
265881082440
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
QUEEN ELIZABETH CENTRAL HOSPITAL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLANTYRE
Provider Business Practice Location Address State Name:
SOUTHERN PROVINCE
Provider Business Practice Location Address Postal Code:
CENTRAL AFRICA
Provider Business Practice Location Address Country Code:
MW
Provider Business Practice Location Address Telephone Number:
265881082440
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  59619 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2086S0102X , with the licence number: 59619 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086X0206X , with the licence number: 59619 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)