Provider Demographics
NPI:1831247386
Name:JOHNSON, ANTHONIO SYSFERELLI (BA)
Entity type:Individual
Prefix:
First Name:ANTHONIO
Middle Name:SYSFERELLI
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:MR
Other - First Name:ANTHONIO
Other - Middle Name:SYSFERELLI
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA
Mailing Address - Street 1:1100 INDIAN TRAIL LILBURN RD APT 1907
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-4576
Mailing Address - Country:US
Mailing Address - Phone:678-558-5379
Mailing Address - Fax:
Practice Address - Street 1:1100 INDIAN TRAIL LILBURN RD APT 1907
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-4576
Practice Address - Country:US
Practice Address - Phone:678-558-5379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health