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General NPI Number Information
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NPI Number | 1073833638
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Entity Type | Organization
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Legal Business Name | MICHAEL R JOHNS PSYD
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Dates
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Enumeration Date | 06/07/2010
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Last Update Date | 06/07/2010
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Provider Practice Location Address
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Address Line | 3678 VINEVILLE AVE
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City | MACON
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State | GA
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Zip | 31204-1868
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Country | US
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Telephone | 478-477-2220
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Fax | 478-477-4455
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Provider Business Mailing Address
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Address Line | 3678 VINEVILLE AVE
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City | MACON
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State | GA
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Zip | 31204-1868
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Country | US
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Telephone | 478-477-2220
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Fax | 478-477-4455
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KATHERINE BOYER
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Credential |
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Telephone | 478-477-2220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY002759
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License Number State | GA
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