Provider Demographics
NPI:1821175332
Name:JOHNSON, RYAN P (ATC)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:P
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 BOYCE GUIN RD
Mailing Address - Street 2:
Mailing Address - City:TIGNALL
Mailing Address - State:GA
Mailing Address - Zip Code:30668-3638
Mailing Address - Country:US
Mailing Address - Phone:706-614-4878
Mailing Address - Fax:
Practice Address - Street 1:350 S MILLEDGE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1048
Practice Address - Country:US
Practice Address - Phone:706-357-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0011262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer