Individual
JENNIFER BEDELL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1000 MEDICAL CENTER BLVD, RADIOLOGY DEPARTMENT, LAWRENCEVILLE, GA 30045-7694
(770) 995-4321
Mailing address
11 MOUNT PARAN RD NE, ATLANTA, GA 30342-2209
(678) 312-2470
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
55604
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01194854
RAILROAD MEDICARE PTAN
MS
Enumeration date
05/24/2007
Last updated
07/17/2023
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