Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | OPT001105 | GA |
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | GA001105 | GA |
NPI | 1063599959 |
---|---|
Provider Name | Dr. David Arlington Johnson |
First Address | Peachtree City, GA 30269-1552 |
Second Address | Peachtree City, GA 30269-1552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 02/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U22626 | (02) | GA |