Healthcare Provider Details

I. General information

NPI: 1932821998
Provider Name (Legal Business Name): DAIJIAH JOHNSON CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/16/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 JOHN WESLEY DOBBS AVE NE UNIT C
ATLANTA GA
30312-1669
US

IV. Provider business mailing address

22 TREEVIEW CT UNIT B
STONECREST GA
30038-1336
US

V. Phone/Fax

Practice location:
  • Phone: 908-875-9321
  • Fax:
Mailing address:
  • Phone: 908-875-9321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number12112-920
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: