Healthcare Provider Details

I. General information

NPI: 1871020008
Provider Name (Legal Business Name): DANIELLE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 CHASTAIN MEADOWS PKWY NW # 200
KENNESAW GA
30144-5881
US

IV. Provider business mailing address

6505 SHILOH RD STE 100
ALPHARETTA GA
30005-1645
US

V. Phone/Fax

Practice location:
  • Phone: 678-648-7644
  • Fax: 678-648-7479
Mailing address:
  • Phone: 678-648-7644
  • Fax: 678-882-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-76332
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: