MEDICARE: D. BRYAN JOHNSON, MD PC

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	049908	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00048268	OTHER	GA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	841074	OTHER	GA	BC/BS

General Provider Information

NPI Number	:	1427247832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D. BRYAN JOHNSON, MD PC

Provider Business Mailing Address
First Line	:	103 CHURCH ST
Second Line	:
City	:	HIAWASSEE
State	:	GA
Zip	:	30546-3223
Country	:	US
Telephone Number	:	706-896-4673
Fax Number	:	706-896-6034

Provider Business Practice Location Address
First Line	:	103 CHURCH ST
Second Line	:
City	:	HIAWASSEE
State	:	GA
Zip	:	30546-3223
Country	:	US
Telephone Number	:	706-896-4673
Fax Number	:	706-896-6034

Authorized Official
Title or Position	:	BILLING SUPERVISOR
Name	:	MRS. ELENA SWINDLER
Credential	:
Telephone Number	:	706-896-9273

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	10/22/2007

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