Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 055843 | GA |
Y | 208200000X | Surgeon | ME124207 | FL |
Y | 208600000X | Surgeon | ME124207 | FL |
NPI | 1649313909 |
---|---|
Provider Name | Dr. Mark Johnson |
First Address | Atlanta, GA 30368-2321 |
Second Address | Atlanta, GA 30309-1281 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 10/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015133000 | (05) | FL |
G06047 | (02) | GA |