Provider Demographics
NPI:1659142636
Name:JOHNS, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:JOHNS
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 1:2361 MAYFIELD WAY CT
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-6227
Mailing Address - Country:US
Mailing Address - Phone:177-090-6585
Mailing Address - Fax:
Practice Address - Street 1:4073 HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-2305
Practice Address - Country:US
Practice Address - Phone:770-882-5884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0033461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical