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General NPI Number Information
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NPI Number | 1760784839
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Entity Type | Individual
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Provider Name | MARTIN THOMAS JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 3330 CUMBERLAND BLVD SE STE 500
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City | ATLANTA
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State | GA
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Zip | 30339-5997
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Country | US
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Telephone | 678-638-6610
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Fax | 888-866-2526
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Provider Business Mailing Address
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Address Line | 5907 BUCKNER CREEK DR
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City | MABLETON
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State | GA
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Zip | 30126-2794
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Country | US
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Telephone | 678-984-7557
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Fax | 678-692-0265
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 049301
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 049301
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License Number State | GA
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