Healthcare Provider Details

I. General information

NPI: 1477989978
Provider Name (Legal Business Name): JESSICA JOHNSON MS, C.G.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W COURT SQ SUITE 766
DECATUR GA
30030-2538
US

IV. Provider business mailing address

1 W COURT SQ SUITE 766
DECATUR GA
30030-2538
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-8640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: