Provider Demographics
NPI:1225255128
Name:JOHNSON, SAMUEL ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ANDREW
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WHITCHER STREET
Mailing Address - Street 2:SUITE 460
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-427-7389
Mailing Address - Fax:770-427-1492
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 460
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-427-7389
Practice Address - Fax:770-427-1492
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA54909207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003123548DMedicaid
GA003123548GMedicaid
GA003123548JMedicaid
GA003123548FMedicaid
GA003123548HMedicaid
GA003123548IMedicaid
GA003123548UMedicaid
GA003123548VMedicaid
GA54909OtherMD
GA003123548EMedicaid
GA003123548OMedicaid
GA003123548PMedicaid
GA003123548KMedicaid
GA003123548MMedicaid
GA003123548BMedicaid
GA003123548CMedicaid
GA003123548SMedicaid
GA003123548LMedicaid
GA003123548RMedicaid
GA003123548TMedicaid
SC29879OtherMEDICAL LICENSE
GA003123548NMedicaid
GA003123548QMedicaid
SC29879OtherMEDICAL LICENSE
GA003123548PMedicaid
GA003123548BMedicaid