Individual
LORIE N. JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3976 HIGHWAY 42, LOCUST GROVE, GA 30248-4104
(678) 429-8146
(678) 814-4708
Mailing address
PO BOX 263, LOCUST GROVE, GA 30248-0263
(678) 429-8146
(770) 288-8642
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
62054
GA
207V00000X
Obstetrics & Gynecology Physician
MD419112L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019726940001
—
PA
05
—
0019726940005
—
PA
01
—
1523078
BLUE SHIELD
PA
05
—
653434213B
—
GA
Enumeration date
04/13/2006
Last updated
12/31/2013
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