Provider Demographics
NPI:1467007641
Name:JOHNSON, CARMETRA DEANN (LMSW)
Entity Type:Individual
Prefix:
First Name:CARMETRA
Middle Name:DEANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 TULLAMORE WAY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-2351
Mailing Address - Country:US
Mailing Address - Phone:404-254-9524
Mailing Address - Fax:
Practice Address - Street 1:157 SMITH ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3546
Practice Address - Country:US
Practice Address - Phone:770-478-2280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW008807104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker