MEDICARE: MR. TREVOR JOHNSON

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	1041C0700X	Clinical Social Worker	005879	CT
2	1041C0700X	Clinical Social Worker	CSW005312	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	:	1912208646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TREVOR JOHNSON

Provider Business Mailing Address
First Line	:	4200 WESTFIELD DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-1838
Country	:	US
Telephone Number	:	203-414-9306
Fax Number	:

Provider Business Practice Location Address
First Line	:	3575 MACON RD STE 731907
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-8200
Country	:	US
Telephone Number	:	203-414-9306
Fax Number	:

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

Provider Enumeration Date	:	11/11/2010
Last Update Date	:	11/17/2018

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Directions to “ MR. TREVOR JOHNSON ” Practice Location

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