Individual
JACQUELINE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2107 GARDENWOOD CT, ATLANTA, GA 30349
(404) 857-8639
Mailing address
2107 GARDENWOOD CT, ATLANTA, GA 30349-3206
(404) 857-8639
(404) 863-1541
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
372320984B
—
GA
Enumeration date
04/11/2008
Last updated
08/01/2019
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