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Individual

GLEN JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MA

Contact information

Practice address
274 BIG A ROAD, TOCCOA, GA 30577-6002
(706) 886-7412
(706) 886-1115
Mailing address
274 BIG A ROAD, TOCCOA, GA 30577-6002
(706) 886-7412
(706) 886-1115

Taxonomy

Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
3575
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000889908A
GA
Enumeration date
08/24/2005
Last updated
05/09/2008
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