Provider Demographics
NPI:1750186961
Name:JOHNSON, SYDNEY THOMAS
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:THOMAS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 ENTERPRISE RD
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-7225
Mailing Address - Country:US
Mailing Address - Phone:229-254-6948
Mailing Address - Fax:
Practice Address - Street 1:763 JESSE JOHNSON DR
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:GA
Practice Address - Zip Code:39823-3224
Practice Address - Country:US
Practice Address - Phone:229-894-9612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical