MEDICARE: TEMEKA L 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	207Q00000X	Family Medicine Physician	RN150824	GA

General Provider Information

NPI Number	:	1316518475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEMEKA L JOHNSON

Provider Business Mailing Address
First Line	:	1023 ROCK HILL PKWY
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-3636
Country	:	US
Telephone Number	:	770-878-2997
Fax Number	:

Provider Business Practice Location Address
First Line	:	1023 ROCK HILL PKWY
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-3636
Country	:	US
Telephone Number	:	770-878-2997
Fax Number	:

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

Provider Enumeration Date	:	07/08/2021
Last Update Date	:	07/08/2021

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