Provider Demographics
NPI:1063428837
Name:JOHNSON, ELIZABETH L (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1000 HAWTHORNE AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2168
Mailing Address - Country:US
Mailing Address - Phone:706-546-0832
Mailing Address - Fax:706-369-5068
Practice Address - Street 1:1000 HAWTHORNE AVE
Practice Address - Street 2:SUITE H
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2168
Practice Address - Country:US
Practice Address - Phone:706-546-0832
Practice Address - Fax:706-369-5068
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA058041207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5111110184Medicare PIN