Individual
MARY ANN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
1277 PARKER RD SE, CONYERS, GA 30094-5957
(678) 615-3056
(678) 623-0136
Mailing address
2601 WEATHERSTONE CIR SE, CONYERS, GA 30094-2015
(770) 686-6822
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
000082
GA
Other
Enumeration date
02/05/2018
Last updated
02/05/2018
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