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General NPI Number Information
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NPI Number | 1083019186
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Entity Type | Organization
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Legal Business Name | CHARLES JOHNSON
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Dates
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Enumeration Date | 10/31/2014
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Last Update Date | 10/31/2014
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Provider Practice Location Address
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Address Line | 234 E PARKWOOD RD
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City | DECATUR
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State | GA
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Zip | 30030-2813
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Country | US
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Telephone | 404-378-5734
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Fax |
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Provider Business Mailing Address
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Address Line | 3397 BRETON CIR NE
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City | ATLANTA
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State | GA
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Zip | 30319-2403
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | CHARLES JOHNSON
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Credential | OTR/L
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Telephone | 404-326-0013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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