1659607679 NPI number — LAURIE ANNE JOHNSON OTR/L, CHT

Table of content: LAURIE ANNE JOHNSON OTR/L, CHT (NPI 1659607679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659607679 NPI number — LAURIE ANNE JOHNSON OTR/L, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
LAURIE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALLEN
Provider Other First Name:
LAURIE
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659607679
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2061 PEACHTREE RD, NE
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30309-1446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-352-3522
Provider Business Mailing Address Fax Number:
865-932-1374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 CHEROKEE STREET
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-795-7979
Provider Business Practice Location Address Fax Number:
865-932-1374
Provider Enumeration Date:
10/27/2009

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: 225X00000X , with the licence number:  4117 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 006251 , 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)





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