Healthcare Provider Details

I. General information

NPI: 1649312026
Provider Name (Legal Business Name): PAUL JONES JOHNSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 WEBB GIN HOUSE RD
SNELLVILLE GA
30078-2042
US

IV. Provider business mailing address

1667 STONY CREEK WAY SW
LILBURN GA
30047-2596
US

V. Phone/Fax

Practice location:
  • Phone: 678-977-8505
  • Fax:
Mailing address:
  • Phone: 678-977-8505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1721
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number1721
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: