Healthcare Provider Details

I. General information

NPI: 1609733716
Provider Name (Legal Business Name): DAN BERNARD JOHNSON JR. PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 SCHOLAR RD
GUYTON GA
31312-6240
US

IV. Provider business mailing address

1912 COLONY PARK RD
AUGUSTA GA
30909-4208
US

V. Phone/Fax

Practice location:
  • Phone: 912-877-2227
  • Fax: 912-877-2332
Mailing address:
  • Phone: 706-589-3863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: