Physician Compare National (NPI:1699764555)

HEALTHCARE PROVIDER: JOHN ALEXANDER JOHNSON M.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	1699764555
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5294919296
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110418000072
	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	JOHN
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	RUTGERS NEW JERSEY MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	1997
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	EMERGENCY MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	EMERGENCY MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	6128 PRESTLEY MILL RD G
	Group Practice or individual's line 1 address
City	DOUGLASVILLE
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	301345622
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	110184
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WELLSTAR DOUGLAS HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y