Individual
DAKOTA LANE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
779 S OLA RD, MCDONOUGH, GA 30252-7180
(678) 815-6135
Mailing address
779 S OLA RD, MCDONOUGH, GA 30252-7180
(678) 815-6135
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT003861
GA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
01/17/2019
Last updated
07/12/2022
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