Provider Demographics
NPI:1891330700
Name:JOHNSON, CARLTON (PHD, RMT)
Entity Type:Individual
Prefix:DR
First Name:CARLTON
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 MOROSGO DR NE UNIT 14623
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-9064
Mailing Address - Country:US
Mailing Address - Phone:470-377-2450
Mailing Address - Fax:
Practice Address - Street 1:1601 SUMMERWOOD DR
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-3097
Practice Address - Country:US
Practice Address - Phone:470-377-2450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty