Provider Demographics
NPI:1619447182
Name:JOHNSON, OTIS FRANFLYN
Entity Type:Individual
Prefix:MR
First Name:OTIS
Middle Name:FRANFLYN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1668 OLDE OAK DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-2736
Mailing Address - Country:US
Mailing Address - Phone:404-840-8575
Mailing Address - Fax:
Practice Address - Street 1:1668 OLDE OAK DR
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-2736
Practice Address - Country:US
Practice Address - Phone:404-840-8575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health