Provider Demographics
NPI:1912672080
Name:JOHNSON, BRANDON RASHAD
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:RASHAD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 AYLESBURY BLVD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-3156
Mailing Address - Country:US
Mailing Address - Phone:678-977-5590
Mailing Address - Fax:
Practice Address - Street 1:292 AYLESBURY BLVD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-3156
Practice Address - Country:US
Practice Address - Phone:678-977-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver