MEDICARE: ARIC JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		GA
2	1041C0700X	Clinical Social Worker		GA

General Provider Information

NPI Number	:	1174188130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIC JOHNSON

Provider Business Mailing Address
First Line	:	2900 DELK RD STE 700, PMB 148
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067
Country	:	US
Telephone Number	:	678-986-1833
Fax Number	:

Provider Business Practice Location Address
First Line	:	2854 JOHNSON FERRY RD STE 200
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-5699
Country	:	US
Telephone Number	:	678-986-1833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2019
Last Update Date	:	05/06/2019

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Directions to “ ARIC JOHNSON ” Practice Location

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