Provider Demographics
NPI:1730151481
Name:JOHNSON-WALL, HELEN NICHOLE (MD)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:NICHOLE
Last Name:JOHNSON-WALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:864-797-6308
Mailing Address - Fax:
Practice Address - Street 1:301 MEMORIAL DR STE F
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-9445
Practice Address - Country:US
Practice Address - Phone:864-885-7758
Practice Address - Fax:864-885-7867
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00351207R00000X, 208M00000X
WA60690598208M00000X
SC82129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist