MEDICARE: CAMERON ALEXANDER JOHNSON DPT

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	225100000X	Physical Therapist	PT017256	GA

General Provider Information

NPI Number	:	1982436382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON ALEXANDER JOHNSON DPT

Provider Business Mailing Address
First Line	:	156 FOSTER DR STE B
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-5346
Country	:	US
Telephone Number	:	770-506-4119
Fax Number	:

Provider Business Practice Location Address
First Line	:	156 FOSTER DR STE B
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-5346
Country	:	US
Telephone Number	:	770-506-4119
Fax Number	:

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

Provider Enumeration Date	:	08/15/2024
Last Update Date	:	08/15/2024

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