Provider Demographics
NPI:1861226904
Name:JOHNSON, MAKAYLA SUMMER (PA-C)
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:SUMMER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-769-0246
Mailing Address - Fax:336-769-9366
Practice Address - Street 1:10479 N NC HIGHWAY 109 STE 107A
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-9884
Practice Address - Country:US
Practice Address - Phone:336-769-0246
Practice Address - Fax:336-769-9366
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical