Individual
MALINDA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, OTR
Contact information
Practice address
354 NEWNAN CROSSING BYP STE 200, NEWNAN, GA 30265-2434
(770) 460-4747
Mailing address
PO BOX 370, FORTSON, GA 31808-0370
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
363A00000X
Physician Assistant
Primary
008486
GA
363A00000X
Physician Assistant
0110006226
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
VVS858A
MEDICARE
VA
Enumeration date
04/22/2007
Last updated
01/29/2021
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