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General NPI Number Information
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NPI Number | 1114374287
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Entity Type | Individual
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Provider Name | MICHAEL JOHNSON SA-C
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Gender | Male
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Dates
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Enumeration Date | 05/19/2016
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Last Update Date | 07/07/2016
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Provider Practice Location Address
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Address Line | 2886 SANDY PLAINS RD
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City | MARIETTA
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State | GA
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Zip | 30066-0240
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Country | US
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Telephone | 404-436-0664
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Fax | 404-393-6142
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Provider Business Mailing Address
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Address Line | 2886 SANDY PLAINS RD
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City | MARIETTA
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State | GA
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Zip | 30066-0240
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Country | US
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Telephone | 404-436-0664
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Fax | 404-393-4162
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 16-399
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License Number State | GA
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