Provider Demographics
NPI:1235271800
Name:JOHNSEY, CARL R JR (OD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:R
Last Name:JOHNSEY
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 SUGARLOAF PKWY
Mailing Address - Street 2:SUITE 513
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-5004
Mailing Address - Country:US
Mailing Address - Phone:678-847-5331
Mailing Address - Fax:678-847-5333
Practice Address - Street 1:5900 SUGARLOAF PKWY
Practice Address - Street 2:SUITE 513
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-5004
Practice Address - Country:US
Practice Address - Phone:678-847-5331
Practice Address - Fax:678-847-5333
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001445152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003129516AMedicaid
202I415003Medicare PIN