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NPI Code Detail

MEDICARE: GLEN JOHNSON MA

MEDICARE: GLEN JOHNSON MA
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
1231H00000XAudiologist3575GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891788980
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLEN JOHNSON MA
Provider Business Mailing Address
First Line : 274 BIG A ROAD
Second Line :
City : TOCCOA
State : GA
Zip : 30577-6002
Country : US
Telephone Number : 706-886-7412
Fax Number : 706-886-1115
Provider Business Practice Location Address
First Line : 274 BIG A ROAD
Second Line :
City : TOCCOA
State : GA
Zip : 30577-6002
Country : US
Telephone Number : 706-886-7412
Fax Number : 706-886-1115
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 05/09/2008

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Directions to “ GLEN JOHNSON MA” Practice Location

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