Provider Demographics
NPI:1871703371
Name:JOHNSON, CHYNNA STEELE (MD)
Entity type:Individual
Prefix:DR
First Name:CHYNNA
Middle Name:STEELE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHYNNA
Other - Middle Name:LYNN
Other - Last Name:STEELE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11500 WEBB BRIDGE WAY
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-2046
Mailing Address - Country:US
Mailing Address - Phone:770-464-6000
Mailing Address - Fax:678-514-2604
Practice Address - Street 1:11500 WEBB BRIDGE WAY
Practice Address - Street 2:SUITE 4A
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-2046
Practice Address - Country:US
Practice Address - Phone:770-464-6000
Practice Address - Fax:678-514-2604
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006014599207N00000X
GA062610207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I076270OtherMEDICARE NUMBER