Provider Demographics
NPI:1376735290
Name:JOHNSON, JANE HORTON (LMT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:HORTON
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4796 CANTON RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3250
Mailing Address - Country:US
Mailing Address - Phone:770-419-4932
Mailing Address - Fax:770-924-7480
Practice Address - Street 1:4796 CANTON RD
Practice Address - Street 2:SUITE 400
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3250
Practice Address - Country:US
Practice Address - Phone:770-419-4932
Practice Address - Fax:770-924-7480
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT 000001225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist