Provider Demographics
NPI:1760793673
Name:JOHNSEN, ANDREW ERLING (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ERLING
Last Name:JOHNSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2874 ELKS CLUB RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-7453
Mailing Address - Country:US
Mailing Address - Phone:770-595-3092
Mailing Address - Fax:
Practice Address - Street 1:3248 AVALON PKWY
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6320
Practice Address - Country:US
Practice Address - Phone:770-922-9706
Practice Address - Fax:770-922-8792
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA72755207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology