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General NPI Number Information
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NPI Number | 1336967249
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Entity Type | Individual
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Provider Name | DANIEL ALAN JOHNSON PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 1301 SIGMAN RD NE STE 125
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City | CONYERS
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State | GA
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Zip | 30012-3820
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Country | US
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Telephone | 678-413-6276
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Fax | 678-413-6277
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Provider Business Mailing Address
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Address Line | 900 CIRCLE 75 PKWY SE STE 1700
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City | ATLANTA
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State | GA
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Zip | 30339-3087
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Country | US
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Telephone | 678-996-7230
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 12501
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License Number State | GA
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