MEDICARE: MR. TERRANCE ALSHARRON JOHNSON SR. CSFA

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	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1366872483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TERRANCE ALSHARRON JOHNSON SR. CSFA

Provider Business Mailing Address
First Line	:	PO BOX 2264
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30077-2264
Country	:	US
Telephone Number	:	678-334-3792
Fax Number	:

Provider Business Practice Location Address
First Line	:	1445 WOODMONT LN NW STE 4471
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2866
Country	:	US
Telephone Number	:	678-334-3792
Fax Number	:	678-324-1439

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

Provider Enumeration Date	:	11/26/2013
Last Update Date	:	01/23/2026

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