Provider Demographics
NPI:1902049505
Name:JOHNSON, HUNTER LAMKIN (MD)
Entity Type:Individual
Prefix:MR
First Name:HUNTER
Middle Name:LAMKIN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3300 BUCKEYE RD
Mailing Address - Street 2:STE 178
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4232
Mailing Address - Country:US
Mailing Address - Phone:770-458-6103
Mailing Address - Fax:770-234-0437
Practice Address - Street 1:1000 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1606
Practice Address - Country:US
Practice Address - Phone:770-458-6103
Practice Address - Fax:770-234-0437
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301104710207ZP0101X, 207ZP0102X, 207ZC0500X
390200000X
GA69297207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003174481AMedicaid
GA003174481AMedicaid