Individual
CAROL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
115 BIRCH HOLLOW TRL NW, MARIETTA, GA 30064-5421
(770) 256-3649
(912) 550-4802
Mailing address
115 BIRCH HOLLOW TRL NW, MARIETTA, GA 30064-5421
(770) 256-3649
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
8190
GA
2251P0200X
Pediatric Physical Therapist
Primary
8190
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10040361
AMERIGROUP
GA
01
—
319309
WELLCARE
GA
05
—
530349285A
—
GA
01
—
8190
PHYSICAL THERAPY LICENSE
GA
Enumeration date
12/13/2006
Last updated
05/17/2021
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