Provider Demographics
NPI:1588622807
Name:JOHNSON, ALCUIN Q (PHD)
Entity Type:Individual
Prefix:
First Name:ALCUIN
Middle Name:Q
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:ALCUIN
Other - Middle Name:QUEARTHUR
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1405 CLIFTON RD NE
Mailing Address - Street 2:3RD FL
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322
Mailing Address - Country:US
Mailing Address - Phone:404-785-1272
Mailing Address - Fax:404-785-1421
Practice Address - Street 1:1405 CLIFTON RD NE
Practice Address - Street 2:3RD FL
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-785-0908
Practice Address - Fax:404-785-6288
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001340103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist