Provider Demographics
NPI:1902167364
Name:JOHNSON, KASSIE SOEFJE (MD)
Entity Type:Individual
Prefix:DR
First Name:KASSIE
Middle Name:SOEFJE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:7 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28580-1332
Mailing Address - Country:US
Mailing Address - Phone:252-747-8162
Mailing Address - Fax:843-408-4615
Practice Address - Street 1:261 BELVOIR HWY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8193
Practice Address - Country:US
Practice Address - Phone:252-695-6352
Practice Address - Fax:252-695-6359
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2023-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXQ1632207QS0010X
NC2020-03203207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine