Provider Demographics
NPI:1518033992
Name:JOHNSON, ROBERT WALKER (DMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WALKER
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:PO BOX 71694
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-1694
Mailing Address - Country:US
Mailing Address - Phone:229-995-5858
Mailing Address - Fax:229-995-4650
Practice Address - Street 1:267 STONEWALL ST SE
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:GA
Practice Address - Zip Code:39842-1440
Practice Address - Country:US
Practice Address - Phone:229-995-5858
Practice Address - Fax:229-995-4650
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA9641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist