Provider Demographics
NPI:1912291352
Name:JOHNSON FAMILY DENTISTRY
Entity Type:Organization
Organization Name:JOHNSON FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-943-2525
Mailing Address - Street 1:5780 CH JAMES PARKWAY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-0000
Mailing Address - Country:US
Mailing Address - Phone:770-943-2525
Mailing Address - Fax:770-943-2527
Practice Address - Street 1:4297 BEN HILL RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-2025
Practice Address - Country:US
Practice Address - Phone:404-343-2544
Practice Address - Fax:404-343-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0141131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty