MEDICARE: LORIE N. JOHNSON MD

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	207V00000X	Obstetrics & Gynecology Physician	MD419112L	PA
2	207V00000X	Obstetrics & Gynecology Physician	62054	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
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	1523078	OTHER	PA	BLUE SHIELD

General Provider Information

NPI Number	:	1770547267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORIE N. JOHNSON MD

Provider Business Mailing Address
First Line	:	PO BOX 263
Second Line	:
City	:	LOCUST GROVE
State	:	GA
Zip	:	30248-0263
Country	:	US
Telephone Number	:	678-429-8146
Fax Number	:	770-288-8642

Provider Business Practice Location Address
First Line	:	3976 HIGHWAY 42
Second Line	:
City	:	LOCUST GROVE
State	:	GA
Zip	:	30248-4104
Country	:	US
Telephone Number	:	678-429-8146
Fax Number	:	678-814-4708

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	12/31/2013

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Directions to “ LORIE N. JOHNSON MD” Practice Location

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