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NPI Code Detail

MEDICARE: JOHNNA JOHNSON PA-C

MEDICARE: JOHNNA JOHNSON PA-C
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
1363A00000XPhysician Assistant00456GA

General Provider Information

NPI Number : 1639173529
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHNNA JOHNSON PA-C
Provider Business Mailing Address
First Line : 3708 NORTHSIDE DR
Second Line :
City : MACON
State : GA
Zip : 31210-2404
Country : US
Telephone Number : 478-254-5303
Fax Number : 478-254-5324
Provider Business Practice Location Address
First Line : 231 GRAEFE ST
Second Line :
City : GRIFFIN
State : GA
Zip : 30224-4222
Country : US
Telephone Number : 770-227-1587
Fax Number : 770-227-1485
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2005
Last Update Date : 10/19/2016

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Directions to “ JOHNNA JOHNSON PA-C” Practice Location

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