Individual
DR. JAY W JOHANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, PHD
Contact information
Practice address
1364 CLIFTON RD NE, ATLANTA, GA 30322-1059
(404) 778-5762
Mailing address
1610 QUEENSLAND CT, ALPHARETTA, GA 30005-6970
(404) 273-5564
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036188
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05BDCRW
—
GA
Enumeration date
07/11/2006
Last updated
09/17/2013
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