MEDICARE: GUNNAR 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	363A00000X	Physician Assistant	PA62215	CA

General Provider Information

NPI Number	:	1770251993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUNNAR JOHNSON

Provider Business Mailing Address
First Line	:	1454 LACHONA CT NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3411
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1454 LACHONA CT NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3411
Country	:	US
Telephone Number	:	650-678-9107
Fax Number	:

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

Provider Enumeration Date	:	09/01/2021
Last Update Date	:	07/08/2025

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Directions to “ GUNNAR JOHNSON ” Practice Location

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