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General NPI Number Information
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NPI Number | 1073490322
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Entity Type | Individual
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Provider Name | ALEXA JOHANSON
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Gender | Female
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 335 OLD RAIL RD
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City | BLOOMINGDALE
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State | GA
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Zip | 31302-4025
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Country | US
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Telephone | 912-421-0140
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Fax |
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Provider Business Mailing Address
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Address Line | 119 RUBY TRL
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City | GUYTON
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State | GA
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Zip | 31312-7001
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Country | US
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Telephone | 912-856-2282
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | PCET004380
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License Number State | GA
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