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General NPI Number Information
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NPI Number | 1760943542
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Entity Type | Individual
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Provider Name | TALIA MARIE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 23 OLD ATLANTA HWY
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City | NEWNAN
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State | GA
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Zip | 30263-6341
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Country | US
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Telephone | 770-251-6868
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Fax |
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Provider Business Mailing Address
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Address Line | 5040 SNAPFINGER WOODS DR STE 203
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City | DECATUR
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State | GA
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Zip | 30035-4020
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Country | US
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Telephone | 269-352-3087
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN122957
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License Number State | GA
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