Healthcare Provider Details

I. General information

NPI: 1235231663
Provider Name (Legal Business Name): BETTY ROOT JOHNSON M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 PIEDMONT RD NE SUITE 210
ATLANTA GA
30305-1506
US

IV. Provider business mailing address

3580 PIEDMONT RD NE SUITE 210
ATLANTA GA
30305-1506
US

V. Phone/Fax

Practice location:
  • Phone: 404-233-9885
  • Fax: 404-233-4880
Mailing address:
  • Phone: 404-233-9885
  • Fax: 404-233-4880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number000739
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000443
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: