1962475582 NPI number — DR. KELLEY MARSHALL JOHNSON MD

Table of content: DR. KELLEY MARSHALL JOHNSON MD (NPI 1962475582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962475582 NPI number — DR. KELLEY MARSHALL JOHNSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
KELLEY
Provider Middle Name:
MARSHALL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARSHALL
Provider Other First Name:
KELLEY
Provider Other Middle Name:
WOODRUFF
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962475582
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CHILDREN'S HEALTHCARE OF ATLANTA
Provider Second Line Business Mailing Address:
2220 NORTH DRUID HILLS ROAD NE-DEPARTMENT OF RADIOLOGY
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-785-6532
Provider Business Mailing Address Fax Number:
770-730-8535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7795 LANDOWNE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30350-1063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-730-8535
Provider Business Practice Location Address Fax Number:
770-730-8535
Provider Enumeration Date:
02/13/2006

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: 2085P0229X , with the licence number:  048372 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085P0229X , with the licence number: 48372 , 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: 7100044200 . This is a "KY MEDICAID-NORTON" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000023033O . This is a "HUMANA/NORTON" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50019563 . This is a "PASSPORT/NORTON" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000568993 . This is a "ANTHEM/NORTON" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 00533044 . This is a "MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 096946 . This is a "SIHO/NORTON" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200928350 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000852893 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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