Provider Demographics
NPI:1417045782
Name:JOHNSON, SUSAN J (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:JO
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3855 PLEASANT HILL RD
Mailing Address - Street 2:STE 100
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096
Mailing Address - Country:US
Mailing Address - Phone:770-495-0155
Mailing Address - Fax:770-813-1298
Practice Address - Street 1:3855 PLEASANT HILL RD
Practice Address - Street 2:STE 100
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:770-495-0155
Practice Address - Fax:770-813-1298
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001791363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant