Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 060281 | GA |
Y | 111NI0900X | Internist | 060281 | GA |
NPI | 1003088642 |
---|---|
Provider Name | Khadeja Jamilia Johnson |
First Address | Atlanta, GA 30310 |
Second Address | Atlanta, GA 30318-3098 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2008 |
Last Update Date | 05/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
79534900B | (05) | GA |