Healthcare Provider Details

I. General information

NPI: 1629780606
Provider Name (Legal Business Name): RACHEL LYNN JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SATELLITE BLVD NW
SUWANEE GA
30024-4651
US

IV. Provider business mailing address

750 SPRINGROCK DR
LAWRENCEVILLE GA
30043-2171
US

V. Phone/Fax

Practice location:
  • Phone: 470-713-0414
  • Fax:
Mailing address:
  • Phone: 404-583-1954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number009653
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: