1447585666 NPI number — DR. RAUSHANNAH N. JOHNSON-VERWAYNE PSY. D.

Table of content: DR. RAUSHANNAH N. JOHNSON-VERWAYNE PSY. D. (NPI 1447585666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447585666 NPI number — DR. RAUSHANNAH N. JOHNSON-VERWAYNE PSY. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON-VERWAYNE
Provider First Name:
RAUSHANNAH
Provider Middle Name:
N.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY. D.
Provider Gender Code:
F

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:
1447585666
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 WYNFIELD WAY SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30331-6837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-879-0639
Provider Business Mailing Address Fax Number:
404-745-8485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3915 CASCADE RD SW
Provider Second Line Business Practice Location Address:
SUITE T-90
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30331-8512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-973-2491
Provider Business Practice Location Address Fax Number:
404-745-8485
Provider Enumeration Date:
10/06/2009

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: 103T00000X , with the licence number:  PSY003324 , 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: PSY003324 . This is a "GEORGIA PROFESSIONAL LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com