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General NPI Number Information
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NPI Number | 1013074012
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Entity Type | Individual
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Provider Name | NATHANIEL JOHNSON III M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3915 CASCADE RD SW STE. T-115
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City | ATLANTA
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State | GA
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Zip | 30331-8512
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Country | US
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Telephone | 404-696-8606
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Fax |
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Provider Business Mailing Address
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Address Line | 300 REGENCY CREST CT SW
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City | ATLANTA
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State | GA
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Zip | 30331-2061
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Country | US
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Telephone | 404-456-1645
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 032336
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License Number State | GA
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