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General NPI Number Information
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NPI Number | 1144865528
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Entity Type | Individual
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Provider Name | LIONEL TERRY JOHNSON OPERATIONS
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Gender | Male
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Dates
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Enumeration Date | 11/09/2019
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Last Update Date | 11/09/2019
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Provider Practice Location Address
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Address Line | 5825 GLENRIDGE DR STE 2-212
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City | ATLANTA
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State | GA
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Zip | 30328-5394
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Country | US
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Telephone | 678-939-2749
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Fax | 404-256-2627
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Provider Business Mailing Address
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Address Line | 5825 GLENRIDGE DR STE 2-214
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City | ATLANTA
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State | GA
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Zip | 30328-5394
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Country | US
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Telephone | 678-939-2749
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Fax | 404-256-2627
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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 | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 00315
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License Number State | GA
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