Provider Demographics
NPI:1730522129
Name:JOHNSON, CHARITY DAWN (DO)
Entity type:Individual
Prefix:DR
First Name:CHARITY
Middle Name:DAWN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CHARITY
Other - Middle Name:DAWN
Other - Last Name:HOLDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:918-499-4855
Mailing Address - Fax:918-488-6098
Practice Address - Street 1:108 LONE OAK CIR
Practice Address - Street 2:
Practice Address - City:FORT GIBSON
Practice Address - State:OK
Practice Address - Zip Code:74434-5001
Practice Address - Country:US
Practice Address - Phone:918-478-6005
Practice Address - Fax:918-478-6020
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5395207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine