Provider Demographics
NPI:1760784839
Name:JOHNSON, MARTIN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:THOMAS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5907 BUCKNER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2794
Mailing Address - Country:US
Mailing Address - Phone:678-984-7557
Mailing Address - Fax:678-692-0265
Practice Address - Street 1:3330 CUMBERLAND BLVD SE STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5997
Practice Address - Country:US
Practice Address - Phone:678-638-6610
Practice Address - Fax:888-866-2526
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0493012084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry