Provider Demographics
NPI:1174692248
Name:JOHNSON, MARTIN K III (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:K
Last Name:JOHNSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 14883
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4883
Mailing Address - Country:US
Mailing Address - Phone:336-274-3241
Mailing Address - Fax:336-272-7134
Practice Address - Street 1:301 E WENDOVER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1230
Practice Address - Country:US
Practice Address - Phone:336-274-3241
Practice Address - Fax:336-274-7134
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2014-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC21573207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1113OtherPARTNERS MEDICARE
NC26035OtherMEDCOST
NC46432OtherBCBS OF NC
NC8946432Medicaid
NC8946432Medicaid
C84745Medicare UPIN
NC110115305Medicare PIN