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General NPI Number Information
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NPI Number | 1568419844
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Entity Type | Individual
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Provider Name | MILES JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 150 FIDDLERS RDG
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-2684
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Country | US
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Telephone | 404-664-4578
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Fax | 770-991-5012
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Provider Business Mailing Address
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Address Line | 2600 MARTIN LUTHER KING JR DR SW STE 100
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City | ATLANTA
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State | GA
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Zip | 30311-1636
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Country | US
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Telephone | 678-556-9460
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Fax | 678-556-9462
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 038817
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License Number State | GA
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