Provider Demographics
NPI:1144508763
Name:JOHNSON, COURTNEY NICOLE (DPT)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9050 PERIDOT PKWY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9417
Mailing Address - Country:US
Mailing Address - Phone:770-474-0540
Mailing Address - Fax:770-507-0506
Practice Address - Street 1:9050 PERIDOT PKWY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9417
Practice Address - Country:US
Practice Address - Phone:770-474-0540
Practice Address - Fax:770-507-0506
Is Sole Proprietor?:No
Enumeration Date:2011-07-31
Last Update Date:2011-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist