Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 44247 | GA |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 44247 | GA |
NPI | 1851373054 |
---|---|
Provider Name | Dr. Joseph T Johnson |
First Address | Athens, GA 30606-2887 |
Second Address | Athens, GA 30606-2853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 21/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10618679 | CAQH NUMBER (01) | |
H41966 | (02) | GA |