Provider Demographics
NPI:1174579940
Name:JOHNSON, CLIFFORD PAUL (MD)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:PAUL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-5616
Mailing Address - Fax:828-687-5616
Practice Address - Street 1:50 HOSPITAL DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5244
Practice Address - Country:US
Practice Address - Phone:828-654-6015
Practice Address - Fax:828-687-6058
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501288208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8946064Medicaid
NCP01030030OtherMEDICARE RR
NC2218452DMedicare PIN
NCP01030030OtherMEDICARE RR
NCG18101Medicare UPIN