Healthcare Provider Details

I. General information

NPI: 1902049505
Provider Name (Legal Business Name): HUNTER LAMKIN JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD
ATLANTA GA
30342-1606
US

IV. Provider business mailing address

3300 BUCKEYE RD STE 178
ATLANTA GA
30341-4232
US

V. Phone/Fax

Practice location:
  • Phone: 770-458-6103
  • Fax: 770-234-0437
Mailing address:
  • Phone: 770-458-6103
  • Fax: 770-234-0437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number4301104710
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4301104710
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number4301104710
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number69297
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: