Kenneth Ray Johnson (NPI# 1962784785, PAC ID# 9335311000) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1962784785 |
| PAC ID by PECOS | 9335311000 |
| Professional Enrollment ID | I20111003000250 |
| Full Name | Kenneth Ray Johnson |
| Organization Legal Name | DERMATOLOGY SPECIALISTS OF AUGUSTA |
| Address |
1203 Town Park Lane Evans GA 30809-3093 |
| Phone Number | 7066507546 |
| Gender | M |
| Medical School | MEDICAL COLLEGE OF GEORGIA |
| Graduation Year | 2011 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 2668447988 |
| Number of Group Practice Members | 3 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 110028 | UNIVERSITY HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 1203 Town Park Lane, Evans, GA 30809-3093 | 7066507546 | DERMATOLOGY SPECIALISTS OF AUGUSTA |
| Organization Legal Name | DERMATOLOGY SPECIALISTS OF AUGUSTA |
| Physicians | 3 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Sanders R Callaway | Dermatology | Dermatology Specialists of Augusta | 1203 Town Park Lane, Evans, GA 30809-3093 |
| Stephen M Squires | Dermatology | Dermatology Specialists of Augusta | 1203 Town Park Lane, Evans, GA 30809-3093 |
| Street Address |
1203 TOWN PARK LANE |
| City | EVANS |
| State | GA |
| Zip | 30809-3093 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Sanders R Callaway | Dermatology | Dermatology Specialists of Augusta | 1203 Town Park Lane, Evans, GA 30809-3093 |
| Stephen M Squires | Dermatology | Dermatology Specialists of Augusta | 1203 Town Park Lane, Evans, GA 30809-3093 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Lisa Wannamaker | Internal Medicine | University Medical Group LLC | 4446 Washington Eroad, Suite 7, Evans, GA 30809 |
| Gena Bonitatibus | Allergy/immunology | 4350 Towne Ctr Dr, Suite 1500, Evans, GA 30809 | |
| Eric J Larson | Chiropractic | 676 Mullins Colony Dr, Evans, GA 30809-0579 | |
| Jonathan William Rutledge | Otolaryngology | Augusta Ent PC | 340 N Belair Rd, Evans, GA 30809-3000 |
| Edward Austin Porubsky | Otolaryngology | Augusta Ent PC | 340 N Belair Rd, Evans, GA 30809-3000 |
| Ralph G Owen | Otolaryngology | Augusta Ent PC | 340 N Belair Rd, Evans, GA 30809-3000 |
| William A Wells | Otolaryngology | Augusta Ent PC | 340 N Belair Rd, Evans, GA 30809-3000 |
| Vanitcha R Pintavorn | Allergy/immunology | Augusta Ent PC | 340 N Belair Rd, Evans, GA 30809-3000 |
| Bari F Levens | Qualified Audiologist | Augusta Ent PC | 340 N Belair Rd, Evans, GA 30809-3000 |
| Robert T Deal | Otolaryngology | Augusta Ent PC | 340 N Belair Rd, Evans, GA 30809-3000 |
| Find all physicians in zip 30809 | |||
| City | EVANS |
| Zip Code | 30809 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | EVANS + PHYSICIAN ASSISTANT |
Please comment or provide details below to improve the information on Kenneth Ray Johnson.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.