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General NPI Number Information
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NPI Number | 1669090130
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Entity Type | Individual
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Provider Name | QUASHON ADAIRE JOHNSON SR. LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/10/2020
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Last Update Date | 07/10/2020
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Provider Practice Location Address
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Address Line | 6635 BASS RD BLDG 92145
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City | FORT BENNING
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State | GA
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Zip | 31905-5602
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Country | US
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Telephone | 706-257-7205
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Fax | 706-626-0827
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Provider Business Mailing Address
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Address Line | 119 BROOK TRL
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City | NEWNAN
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State | GA
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Zip | 30265-6140
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Country | US
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Telephone | 404-735-1366
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7087
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License Number State | OK
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