Provider Demographics
NPI:1033795398
Name:JOHNSON, NETOYA (BSDH, RDH)
Entity Type:Individual
Prefix:
First Name:NETOYA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BSDH, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5585 FESTIVAL AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-5503
Mailing Address - Country:US
Mailing Address - Phone:678-632-5616
Mailing Address - Fax:
Practice Address - Street 1:5585 FESTIVAL AVE
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-5503
Practice Address - Country:US
Practice Address - Phone:678-632-5616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH043821124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty