Provider Demographics
NPI:1619927357
Name:JOHNSON, WHITNEY DAWN (PT)
Entity Type:Individual
Prefix:MS
First Name:WHITNEY
Middle Name:DAWN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 MAGNOLIA WAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9481
Mailing Address - Country:US
Mailing Address - Phone:706-210-7529
Mailing Address - Fax:706-312-7613
Practice Address - Street 1:1706 MAGNOLIA WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-9481
Practice Address - Country:US
Practice Address - Phone:706-210-7529
Practice Address - Fax:706-312-7613
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001124225100000X
OH06214225100000X
GA008908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2460804Medicaid
WV0156624000Medicaid
GA705253983AMedicaid
GA705253983AMedicaid
GA65BBDXCMedicare PIN