Healthcare Provider Details

I. General information

NPI: 1962699850
Provider Name (Legal Business Name): CARRIE JOHNSON PHARMD, BCPS, BCACP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 CASCADE PKWY SW
ATLANTA GA
30311-3090
US

IV. Provider business mailing address

1175 CASCADE PKWY SW
ATLANTA GA
30311-3090
US

V. Phone/Fax

Practice location:
  • Phone: 404-505-4039
  • Fax:
Mailing address:
  • Phone: 404-505-4039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS43019
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH025454
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: