MEDICARE: LONNIE 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	332B00000X	Durable Medical Equipment & Medical Supplies	1001300	TX

General Provider Information

NPI Number	:	1659825198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONNIE JOHNSON

Provider Business Mailing Address
First Line	:	3061 MILFORD CHASE SW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30008-6882
Country	:	US
Telephone Number	:	404-242-9881
Fax Number	:	770-433-0682

Provider Business Practice Location Address
First Line	:	1750 POWDER SPRINGS RD SW STE 190
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-4861
Country	:	US
Telephone Number	:	404-242-9881
Fax Number	:	770-433-0682

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

Provider Enumeration Date	:	08/13/2016
Last Update Date	:	08/13/2016

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Directions to “ LONNIE JOHNSON ” Practice Location

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