Healthcare Provider Details

I. General information

NPI: 1497625016
Provider Name (Legal Business Name): AMARIYAH TIANA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2025
Last Update Date: 11/19/2025
Certification Date: 11/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8279 WALNUT DR
JONESBORO GA
30238-3138
US

IV. Provider business mailing address

8279 WALNUT DR
JONESBORO GA
30238-3138
US

V. Phone/Fax

Practice location:
  • Phone: 678-826-7860
  • Fax:
Mailing address:
  • Phone: 678-826-7860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: