MEDICARE: DIANNE JEAN-MARIE BENNETT-JOHNSON M.D.

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	207R00000X	Internal Medicine Physician	037957	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386724599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNE JEAN-MARIE BENNETT-JOHNSON M.D.

Provider Business Mailing Address
First Line	:	6050 PEACHTREE PKWY
Second Line	:	SUITE 240-375
City	:	NORCROSS
State	:	GA
Zip	:	30092-3336
Country	:	US
Telephone Number	:	770-279-2427
Fax Number	:	770-279-0639

Provider Business Practice Location Address
First Line	:	483 INDIAN TRAIL LILBURN RD NW
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-3717
Country	:	US
Telephone Number	:	770-279-2427
Fax Number	:	770-279-0639

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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