Provider Demographics
NPI:1891193769
Name:JOHNSON, KEMYAUNA MAURAY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KEMYAUNA
Middle Name:MAURAY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 CREST RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5758
Mailing Address - Country:US
Mailing Address - Phone:470-419-1940
Mailing Address - Fax:470-346-2821
Practice Address - Street 1:777 CLEVELAND AVE SW STE 305
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-7118
Practice Address - Country:US
Practice Address - Phone:404-539-3882
Practice Address - Fax:470-346-2821
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist