MEDICARE: JENNA JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-26-513339	GA

General Provider Information

NPI Number	:	1114883493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA JOHNSON

Provider Business Mailing Address
First Line	:	4559 W ELLIS RD
Second Line	:
City	:	GRIFFIN
State	:	GA
Zip	:	30223-6822
Country	:	US
Telephone Number	:	470-204-5788
Fax Number	:

Provider Business Practice Location Address
First Line	:	4559 W ELLIS RD
Second Line	:
City	:	GRIFFIN
State	:	GA
Zip	:	30223-6822
Country	:	US
Telephone Number	:	470-204-5788
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	02/06/2026

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Directions to “ JENNA JOHNSON ” Practice Location

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