Provider Demographics
NPI:1235231663
Name:JOHNSON, BETTY ROOT (MED)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:ROOT
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 PIEDMONT RD NE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1506
Mailing Address - Country:US
Mailing Address - Phone:404-233-9885
Mailing Address - Fax:404-233-4880
Practice Address - Street 1:3580 PIEDMONT RD NE
Practice Address - Street 2:SUITE 210
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1506
Practice Address - Country:US
Practice Address - Phone:404-233-9885
Practice Address - Fax:404-233-4880
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000739101YP2500X
GA000443106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist