MEDICARE: METTA SWEET JOHNSON M.S.W., L.C.S.W

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	CSW003686	GA

General Provider Information

NPI Number	:	1962607093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	METTA SWEET JOHNSON M.S.W., L.C.S.W

Provider Business Mailing Address
First Line	:	755 PARK DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-3681
Country	:	US
Telephone Number	:	404-549-9132
Fax Number	:

Provider Business Practice Location Address
First Line	:	1945 MASON MILL RD
Second Line	:	SUITE 100
City	:	DECATUR
State	:	GA
Zip	:	30033-4006
Country	:	US
Telephone Number	:	404-221-3238
Fax Number	:

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	07/08/2007

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