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General NPI Number Information
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NPI Number | 1003103870
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Entity Type | Individual
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Provider Name | COURTNEY PARHAM JOHNSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/30/2011
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Last Update Date | 03/13/2015
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Provider Practice Location Address
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Address Line | 204 PROFESSIONAL CT SE
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City | CALHOUN
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State | GA
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Zip | 30701-7020
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Country | US
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Telephone | 706-625-5900
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Fax | 706-625-6519
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Provider Business Mailing Address
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Address Line | 346 PEACHTREE LN SE
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City | CALHOUN
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State | GA
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Zip | 30701-4388
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Country | US
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Telephone | 423-838-3407
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 006117
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License Number State | GA
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