1225255128 NPI number — DR. SAMUEL ANDREW JOHNSON MD

Table of content: (NPI 1437541695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225255128 NPI number — DR. SAMUEL ANDREW JOHNSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
SAMUEL
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225255128
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 WHITCHER STREET
Provider Second Line Business Mailing Address:
SUITE 460
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30060-1155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-427-7389
Provider Business Mailing Address Fax Number:
770-427-1492

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 WHITCHER ST NE
Provider Second Line Business Practice Location Address:
SUITE 460
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30060-1155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-427-7389
Provider Business Practice Location Address Fax Number:
770-427-1492
Provider Enumeration Date:
04/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  54909 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003123548D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003123548G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003123548J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003123548F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003123548H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003123548I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003123548U , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003123548V , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54909 . This is a "MD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 003123548E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003123548O , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003123548P , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003123548K , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003123548M , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003123548B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003123548C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003123548S , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003123548L , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003123548R , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003123548T , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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