Healthcare Provider Details

I. General information

NPI: 1174515746
Provider Name (Legal Business Name): GINA RYAN JOHNSON PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: GINA JOYCE RYAN PHARM.D.

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4468 LYNGATE DR SW
LILBURN GA
30047-8962
US

IV. Provider business mailing address

3001 MERCER UNIVERSITY DR
ATLANTA GA
30341-4115
US

V. Phone/Fax

Practice location:
  • Phone: 770-923-6481
  • Fax:
Mailing address:
  • Phone: 678-547-6222
  • Fax: 678-547-6384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number018819
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: