Healthcare Provider Details

I. General information

NPI: 1679573141
Provider Name (Legal Business Name): JULIE JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CORPORATE CENTER DR SUITE 200
MORROW GA
30260-4180
US

IV. Provider business mailing address

1000 CORPORATE CENTER DR
MORROW GA
30260-4180
US

V. Phone/Fax

Practice location:
  • Phone: 770-968-6464
  • Fax: 770-968-6465
Mailing address:
  • Phone: 770-968-6464
  • Fax: 770-968-6465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number049514
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: