Provider Demographics
NPI:1841611852
Name:JOHNSON, EMILY HANNAH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:HANNAH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:HANNAH
Other - Last Name:RUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 STONEFOREST DR STE 130
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-4881
Mailing Address - Country:US
Mailing Address - Phone:678-388-1621
Mailing Address - Fax:678-391-5099
Practice Address - Street 1:61 WHITCHER ST STE 2100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:770-423-0595
Practice Address - Fax:678-391-5055
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7075363AM0700X
GA2548363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant