Individual
PETER CHARLES JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
965 HAWTHORNE PRK., SUITE 100A, ATHENS, GA 30086
(706) 369-1200
(706) 369-0540
Mailing address
PO BOX 1390, STONE MOUNTAIN, GA 30086-1390
(706) 369-1200
(706) 369-0540
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
034378
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000483755M
—
GA
Enumeration date
09/28/2006
Last updated
05/05/2008
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