Provider Demographics
NPI:1245418987
Name:JOHNSON, DINIKA SHANNELLE (ATC)
Entity Type:Individual
Prefix:MS
First Name:DINIKA
Middle Name:SHANNELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 26TH ST NW
Mailing Address - Street 2:APT 1403
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1914
Mailing Address - Country:US
Mailing Address - Phone:704-649-1055
Mailing Address - Fax:
Practice Address - Street 1:150 BOBBY DODD WAY NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30332-0001
Practice Address - Country:US
Practice Address - Phone:404-894-3692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer