Provider Demographics
NPI:1003320763
Name:DR. BEN JOHNSON SERVICES LLC
Entity Type:Organization
Organization Name:DR. BEN JOHNSON SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DO, NMD
Authorized Official - Phone:818-331-1844
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:HELEN
Mailing Address - State:GA
Mailing Address - Zip Code:30545-0014
Mailing Address - Country:US
Mailing Address - Phone:818-331-1844
Mailing Address - Fax:
Practice Address - Street 1:705 BRUCKEN STRASSE BLDG 101
Practice Address - Street 2:
Practice Address - City:HELEN
Practice Address - State:GA
Practice Address - Zip Code:30545-3606
Practice Address - Country:US
Practice Address - Phone:818-331-1844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA23999261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care