=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316518475
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TEMEKA L JOHNSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2021
-----------------------------------------------------
Last Update Date | 07/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1023 ROCK HILL PKWY
-----------------------------------------------------
City | LITHIA SPRINGS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30122-3636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-878-2997
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1023 ROCK HILL PKWY
-----------------------------------------------------
City | LITHIA SPRINGS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30122-3636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-878-2997
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | RN150824
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------