Healthcare Provider Details

I. General information

NPI: 1376855080
Provider Name (Legal Business Name): QUINETTA BRIGETTE JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 CHURCH ST NE STE 230
MARIETTA GA
30060-1132
US

IV. Provider business mailing address

699 CHURCH ST NE STE 230
MARIETTA GA
30060-1132
US

V. Phone/Fax

Practice location:
  • Phone: 470-267-1980
  • Fax: 470-986-7054
Mailing address:
  • Phone: 470-267-1980
  • Fax: 470-986-7054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number59709
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number49124
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number97397
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301097155
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number49124
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: