MEDICARE: MR. SCOTT BRADLEY 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	2255R0406X	Blind Rehabilitation Specialist/Technologist

General Provider Information

NPI Number	:	1609888155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT BRADLEY JOHNSON

Provider Business Mailing Address
First Line	:	3919 CREEKWOOD LN
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30907-2423
Country	:	US
Telephone Number	:	706-868-9008
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 FREEDOM WAY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30904-6258
Country	:	US
Telephone Number	:	706-733-0188
Fax Number	:	706-481-6703

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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