Provider Demographics
NPI:1376855080
Name:JOHNSON, QUINETTA BRIGETTE (MD)
Entity Type:Individual
Prefix:
First Name:QUINETTA
Middle Name:BRIGETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 CHURCH ST NE STE 230
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1132
Mailing Address - Country:US
Mailing Address - Phone:470-267-1980
Mailing Address - Fax:470-986-7054
Practice Address - Street 1:699 CHURCH ST NE STE 230
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1132
Practice Address - Country:US
Practice Address - Phone:470-267-1980
Practice Address - Fax:470-986-7054
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN59709207VM0101X
KY49124207VM0101X, 207VG0400X
GA97397207VM0101X
MI4301097155207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology