Healthcare Provider Details

I. General information

NPI: 1164682134
Provider Name (Legal Business Name): PAUL MCPHERSON JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PRINCE AVE MSB 2ND FLOOR
ATHENS GA
30606-2797
US

IV. Provider business mailing address

PO BOX 161435
ATLANTA GA
30321-1435
US

V. Phone/Fax

Practice location:
  • Phone: 706-475-1700
  • Fax: 706-475-1790
Mailing address:
  • Phone: 706-369-5474
  • Fax: 706-369-5490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number075306
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number075306
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: