Provider Demographics
NPI:1659500072
Name:DIAS, JOHNNY ABRAHAM (DO)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:ABRAHAM
Last Name:DIAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 HARDING PLACE
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204
Mailing Address - Country:US
Mailing Address - Phone:704-468-3100
Mailing Address - Fax:
Practice Address - Street 1:1237 HARDING PLACE
Practice Address - Street 2:SUITE 2600
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204
Practice Address - Country:US
Practice Address - Phone:704-468-3100
Practice Address - Fax:704-468-3120
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37770208M00000X, 207R00000X
NC2014-00110207R00000X
VA0102202781207R00000X
DCUNLICENSED207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC377700Medicaid
SCSC81129068Medicare PIN
SC377700Medicaid