Individual
MRS. ELISSAVETA B JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M. S., R.D., L.D.
Contact information
Practice address
601 DALLAS HWY, VILLA RICA, GA 30180-1202
(770) 456-3249
(770) 456-3351
Mailing address
4012 SHADED OASIS LN, VILLA RICA, GA 30180-6966
(706) 506-5379
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD003412
GA
Other
Enumeration date
03/05/2010
Last updated
03/05/2010
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