Provider Demographics
NPI:1790254019
Name:JOHNSON, ASHLEY (PT)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
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 1:6740 SHANNON PKWY STE 14
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-2061
Mailing Address - Country:US
Mailing Address - Phone:404-388-3811
Mailing Address - Fax:
Practice Address - Street 1:6740 SHANNON PKWY STE 14
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-2061
Practice Address - Country:US
Practice Address - Phone:404-388-3811
Practice Address - Fax:404-393-7533
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT324002251X0800X
GAPT0143372251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic