Provider Demographics
NPI:1679576854
Name:JOHNSON, JOHN T (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 KAPLAND CT
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-3078
Mailing Address - Country:US
Mailing Address - Phone:706-542-5366
Mailing Address - Fax:706-542-5228
Practice Address - Street 1:112 PARK AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-1722
Practice Address - Country:US
Practice Address - Phone:706-425-9445
Practice Address - Fax:706-425-9445
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20226183500000X
SC6840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist