Basic Information
| Provider Information | |||||||||
| NPI: | 1144545831 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHANSON | ||||||||
| FirstName: | ERIK | ||||||||
| MiddleName: | FRANK | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2585 HENDERSONVILLE RD | ||||||||
| Address2: | |||||||||
| City: | ARDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287049577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282588800 | ||||||||
| FaxNumber: | 8286510026 | ||||||||
| Practice Location | |||||||||
| Address1: | 2293 SUGAR HILL RD STE D | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287527787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286528727 | ||||||||
| FaxNumber: | 8286528793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2010 | ||||||||
| LastUpdateDate: | 12/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0010-02245 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1144545831 | 05 | NC | MEDICAID |