MEDICARE: VEDA C 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	208000000X	Pediatrics Physician	029894	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

General Provider Information

NPI Number	:	1780611996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VEDA C JOHNSON MD

Provider Business Mailing Address
First Line	:	2015 UPPERGATE DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-0001
Country	:	US
Telephone Number	:	404-522-0101
Fax Number	:	404-588-0226

Provider Business Practice Location Address
First Line	:	35 WHITEFOORD AVE SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30317-1727
Country	:	US
Telephone Number	:	404-588-0101
Fax Number	:	404-588-0226

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	07/08/2007

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