Provider Demographics
NPI:1700040060
Name:ALLYN C JOHNSON JR MDPC
Entity Type:Organization
Organization Name:ALLYN C JOHNSON JR MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BELLOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-532-9973
Mailing Address - Street 1:675 WHITE SULPHUR RD
Mailing Address - Street 2:SUITE #280
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-8921
Mailing Address - Country:US
Mailing Address - Phone:770-532-9973
Mailing Address - Fax:770-503-0775
Practice Address - Street 1:675 WHITE SULPHUR RD
Practice Address - Street 2:SUITE #280
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-8921
Practice Address - Country:US
Practice Address - Phone:770-532-9973
Practice Address - Fax:770-503-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA06661207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00269992BMedicaid
GAD45774Medicare UPIN
GA106661110AMedicare PIN