=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093198913
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH ANN JOHNSON D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2015
-----------------------------------------------------
Last Update Date | 12/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 623 N MILLEDGE AVE
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30601-3801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-227-3292
-----------------------------------------------------
Fax | 888-809-9345
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 623 N MILLEDGE AVE
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30601-3801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-227-3292
-----------------------------------------------------
Fax | 888-809-9345
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIRO09670
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------