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General NPI Number Information
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NPI Number | 1699936211
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Entity Type | Individual
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Provider Name | HELENA RENEE JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 06/17/2008
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 6849 PEACHTREE DUNWOODY RD NE SUITE 102
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City | ATLANTA
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State | GA
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Zip | 30328-1610
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Country | US
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Telephone | 186-658-7992
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Fax |
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Provider Business Mailing Address
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Address Line | 207 COLONY PARK DR
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City | PEARL
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State | MS
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Zip | 39208-6282
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Country | US
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Telephone | 601-832-3200
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT004735
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License Number State | GA
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