Basic Information
| Provider Information | |||||||||
| NPI: | 1871607275 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1171 UNIVERSITY RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895124556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7755447117 | ||||||||
| FaxNumber: | 7753281718 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 LOCUST ST | ||||||||
| Address2: | RENO VAMC | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895022597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753281760 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 19623 | AL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.