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General NPI Number Information
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NPI Number | 1659825198
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Entity Type | Individual
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Provider Name | LONNIE JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 08/13/2016
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Last Update Date | 08/13/2016
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Provider Practice Location Address
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Address Line | 1750 POWDER SPRINGS RD SW STE 190
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City | MARIETTA
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State | GA
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Zip | 30064-4861
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Country | US
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Telephone | 404-242-9881
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Fax | 770-433-0682
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Provider Business Mailing Address
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Address Line | 3061 MILFORD CHASE SW
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City | MARIETTA
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State | GA
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Zip | 30008-6882
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Country | US
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Telephone | 404-242-9881
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Fax | 770-433-0682
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1001300
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License Number State | TX
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