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NPI Code Detail

MEDICARE: CARLOS R JOHNSON DPT

MEDICARE:   CARLOS R JOHNSON  DPT
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
1225100000XPhysical TherapistPT011382GA

General Provider Information

NPI Number : 1710381165
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLOS R JOHNSON DPT
Provider Business Mailing Address
First Line : 80 TECHNACENTER DR
Second Line : SUITE 300
City : MONTGOMERY
State : AL
Zip : 36117-6028
Country : US
Telephone Number : 334-625-5795
Fax Number : 334-396-4905
Provider Business Practice Location Address
First Line : 4849 S COBB DR SE
Second Line : SUITE 121
City : SMYRNA
State : GA
Zip : 30080-7145
Country : US
Telephone Number : 770-438-5220
Fax Number : 770-438-4367
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2014
Last Update Date : 03/16/2016

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Directions to “ CARLOS R JOHNSON DPT” Practice Location

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