MEDICARE: CHRISTIAN MARIE JOHNSON D.D.S.

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	122300000X	Dentist	3045	OH
2	122300000X	Dentist	DN014556	GA

General Provider Information

NPI Number	:	1346536125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN MARIE JOHNSON D.D.S.

Provider Business Mailing Address
First Line	:	1155 CONCORD RD SE STE 110
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-4255
Country	:	US
Telephone Number	:	770-520-8443
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 CONCORD RD SE STE 110
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-4255
Country	:	US
Telephone Number	:	770-520-8443
Fax Number	:

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

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	08/01/2023

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