Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Kenneth Ray Johnson, PA-C

Individual provider Medical Physician Assistant · NPI 1962784785

Mr. Kenneth Ray Johnson, PA-C is a Physician Assistant in Evans, Georgia. Graduated from Medical College of Georgia School of Medicine in 2011, 15 years ago. Practices with Dermatology Specialists of Augusta, Inc, a 6-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
15
Trained at
Medical College of Georgia School of Medicine
Licensed in
GA
In the registry since
2011
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1203 Town Park Ln
Evans, GA 30809
Phone: (706) 650-7546
Fax: (706) 922-9168
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 6259 (GA)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 6259 (GA)

Record details

NPI number1962784785
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 19, 2011
Last updated in NPPESJune 29, 2018

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolMEDICAL COLLEGE OF GEORGIA SCHOOL OF MEDICINE
Graduated 2011 (15 years in practice)
Group practice Dermatology Specialists Of Augusta, Inc — 6 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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