MEDICARE: DR. SAMANTHA KAYE JOHNSON DDS

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	1223G0001X	General Practice Dentistry	DN014944	GA
2	1223G0001X	General Practice Dentistry	53131	CA
3	1223G0001X	General Practice Dentistry	24511	TX
4	122300000X	Dentist	14944	GA
5	1223G0001X	General Practice Dentistry	049903	NY

General Provider Information

NPI Number	:	1821026030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMANTHA KAYE JOHNSON DDS

Provider Business Mailing Address
First Line	:	2970 PEACHTREE RD NW STE 660
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2115
Country	:	US
Telephone Number	:	404-237-6464
Fax Number	:	404-266-8567

Provider Business Practice Location Address
First Line	:	2970 PEACHTREE RD NW STE 660
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2115
Country	:	US
Telephone Number	:	404-237-6464
Fax Number	:	404-266-8567

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	08/27/2024

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