Physician Compare National (NPI:1184703464)

HEALTHCARE PROVIDER: PHILLIP E JOHNSON O.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1184703464
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6002869773
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050223000347
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JOHNSON
	Individual professional last name
Provider First Name	PHILLIP
	Individual professional first name
Provider Middle Name	E
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	OD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	SOUTHERN COLLEGE OF OPTOMETRY
	Individual professional's medical school
Graduation Year	1977
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	3455 PEACHTREE INDUSTRIAL BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 845
	Group Practice or individual's line 2 address
City	DULUTH
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	300966503
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y