MEDICARE: VANITA JOHNSON DPM

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	213E00000X	Podiatrist	POD001019	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	:	1902868235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANITA JOHNSON DPM

Provider Business Mailing Address
First Line	:	PO BOX 142014
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30219
Country	:	US
Telephone Number	:	404-964-6325
Fax Number	:	404-745-8603

Provider Business Practice Location Address
First Line	:	4001 DANFORTH ROAD SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30303
Country	:	US
Telephone Number	:	330-758-4515
Fax Number	:	330-758-5121

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	05/05/2008

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