| Michael O Johnson Physician Assistant Pllc | |
|
377 W Pike St # A3-2 Lawrenceville GA 30046-4881 | |
| (470) 461-7031 | |
| (720) 502-6820 |
| Full Name | Michael O Johnson Physician Assistant Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 377 W Pike St # A3-2, Lawrenceville, Georgia |
| Authorized Official Name and Position | Michael Johnson (PROVIDER) |
| Authorized Official Contact | 3475463594 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael O Johnson Physician Assistant Pllc 377 W Pike St # A3-2 Lawrenceville GA 30046-4881 Ph: (470) 461-7031 | Michael O Johnson Physician Assistant Pllc 377 W Pike St # A3-2 Lawrenceville GA 30046-4881 Ph: (470) 461-7031 |
| NPI Number | 1508542812 |
|---|---|
| Provider Enumeration Date | 06/22/2023 |
| Last Update Date | 06/22/2023 |
| Medicare PECOS PAC ID | 5698135150 |
|---|---|
| Medicare Enrollment ID | O20230714002625 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508542812 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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