DR. GRADY EARL JOHNSON DMD NPI 1861508715

NPI Information

  • NPI: 1861508715
  • Provider Name: DR. GRADY EARL JOHNSON, DMD
  • Classification: Dentist - 1223G0001X
  • Specialization: General Practice
  • Entity Type: Individual
  • Address: 4273 POINT LA VISTA RD S
    JACKSONVILLE, FL
    ZIP 32207
  • Phone: (904) 398-0404

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NPI Details

DR. Grady Earl Johnson, DMD is a general practice dentist in Jacksonville, FL. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. DR. Grady Earl Johnson, DMD NPI is 1861508715. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4273 POINT LA VISTA RD S
JACKSONVILLE, FL
ZIP 32207-243
Phone: (904) 398-0404
Fax: (904) 398-0404

The enumeration date for this NPI number is 8/22/2006 and was last updated on 3/7/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral PracticeDN 7137FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1074459000MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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