Provider Demographics
NPI:1336538974
Name:JOHNSON, MICHAEL MARTIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:MARTIN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2020 HONEY CREEK SE PKWY
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2974
Mailing Address - Country:US
Mailing Address - Phone:770-929-0813
Mailing Address - Fax:770-929-3868
Practice Address - Street 1:2020 HONEY CREEK PKWY SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2974
Practice Address - Country:US
Practice Address - Phone:770-929-0813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical