MEDICARE: JOHNSON FAMILY PRACTICE LLC

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		GA

General Provider Information

NPI Number	:	1487630018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSON FAMILY PRACTICE LLC

Provider Business Mailing Address
First Line	:	PO BOX 138
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31902-0138
Country	:	US
Telephone Number	:	706-327-4797
Fax Number	:	706-324-4131

Provider Business Practice Location Address
First Line	:	2411 WARM SPRINGS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5637
Country	:	US
Telephone Number	:	706-327-4797
Fax Number	:	706-324-4131

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	C DENTON JOHNSON
Credential	:	MD
Telephone Number	:	706-327-4797

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	07/21/2022

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Directions to “JOHNSON FAMILY PRACTICE LLC ” Practice Location

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