Provider Demographics
NPI:1508542812
Name:MICHAEL O JOHNSON PHYSICIAN ASSISTANT PLLC
Entity Type:Organization
Organization Name:MICHAEL O JOHNSON PHYSICIAN ASSISTANT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-546-3594
Mailing Address - Street 1:377 W PIKE ST # A3-2
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4881
Mailing Address - Country:US
Mailing Address - Phone:470-461-7031
Mailing Address - Fax:720-502-6820
Practice Address - Street 1:377 W PIKE ST # A3-2
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4881
Practice Address - Country:US
Practice Address - Phone:470-461-7031
Practice Address - Fax:720-502-6820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care