Provider Demographics
NPI:1902871155
Name:JOHNSON, DAVID P (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:P
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:535 JESSE JEWELL PARKWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501
Mailing Address - Country:US
Mailing Address - Phone:770-534-9014
Mailing Address - Fax:770-534-9012
Practice Address - Street 1:535 JESSE JEWELL PARKWAY
Practice Address - Street 2:SUITE C
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-534-9014
Practice Address - Fax:770-534-9012
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2018-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA32757207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000646874GMedicaid
GA000646874GMedicaid
GA202I061741Medicare PIN
GA000646874GMedicaid
GA06BDCZLMedicare PIN