Provider Demographics
NPI:1851054746
Name:JOHNSON, DEVONTE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEVONTE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6256 PHILLIPS LAKE CV
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3932
Mailing Address - Country:US
Mailing Address - Phone:678-463-7076
Mailing Address - Fax:
Practice Address - Street 1:587 VIRGINIA AVE NE STE 5
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-3688
Practice Address - Country:US
Practice Address - Phone:404-389-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1225121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice