Healthcare Provider Details

I. General information

NPI: 1760943369
Provider Name (Legal Business Name): CAL JAMES JOHNSON III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 03/27/2019
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

3155 N POINT PKWY STE F100
ALPHARETTA GA
30005-5495
US

V. Phone/Fax

Practice location:
  • Phone: 770-645-9181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN208411
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: