Healthcare Provider Details

I. General information

NPI: 1245579986
Provider Name (Legal Business Name): JOHNSON AUDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W MAIN ST
CARTERSVILLE GA
30120-3507
US

IV. Provider business mailing address

105 W MAIN ST
CARTERSVILLE GA
30120-3507
US

V. Phone/Fax

Practice location:
  • Phone: 770-334-3062
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: JAMES D JOHNSON
Title or Position: OWNER
Credential:
Phone: 770-334-3062