Individual
MR. CLYDE D JOHNSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSA
Contact information
Practice address
5881 GLENDRIGE DR NE, SUITE 120, ATLANTA, GA 30328
(404) 303-7703
Mailing address
5881 GLENDRIGE DR NE, SUITE 120, ATLANTA, GA 30328
(404) 303-7703
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2625-2
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
359555800
DEPT OF LABOR
GA
Enumeration date
06/02/2008
Last updated
09/22/2017
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