Healthcare Provider Details

I. General information

NPI: 1649260415
Provider Name (Legal Business Name): ROBERT PAUL JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE EMORY UNIVERSITY HOSPITAL
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

954 GATEWOOD RD NE YERKES/EMORY UNIVERSITY
ATLANTA GA
30329-4208
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-2000
  • Fax:
Mailing address:
  • Phone: 404-727-7707
  • Fax: 404-727-0623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number59359
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number59359
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number72334
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: