Provider Demographics
NPI:1447585666
Name:JOHNSON-VERWAYNE, RAUSHANNAH N (PSY D)
Entity Type:Individual
Prefix:DR
First Name:RAUSHANNAH
Middle Name:N
Last Name:JOHNSON-VERWAYNE
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WYNFIELD WAY SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-6837
Mailing Address - Country:US
Mailing Address - Phone:757-879-0639
Mailing Address - Fax:404-745-8485
Practice Address - Street 1:3915 CASCADE RD SW
Practice Address - Street 2:SUITE T-90
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8512
Practice Address - Country:US
Practice Address - Phone:678-973-2491
Practice Address - Fax:404-745-8485
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003324103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPSY003324OtherGEORGIA PROFESSIONAL LICENSE