Healthcare Provider Details

I. General information

NPI: 1780302182
Provider Name (Legal Business Name): ZAKLYN JOHNSON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 TREES OF AVALON PKWY APT 3121
MCDONOUGH GA
30253-7619
US

IV. Provider business mailing address

3121 TREES OF AVALON PKWY APT 3121
MCDONOUGH GA
30253-7619
US

V. Phone/Fax

Practice location:
  • Phone: 478-284-1066
  • Fax:
Mailing address:
  • Phone: 478-284-1066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH012641
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: