Provider Demographics
NPI:1366872483
Name:JOHNSON, TERRANCE ALSHARRON SR (CSFA)
Entity type:Individual
Prefix:MR
First Name:TERRANCE
Middle Name:ALSHARRON
Last Name:JOHNSON
Suffix:SR
Gender:M
Credentials:CSFA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2264
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30077-2264
Mailing Address - Country:US
Mailing Address - Phone:678-334-3792
Mailing Address - Fax:
Practice Address - Street 1:6339 ANSLEY CIR
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-1308
Practice Address - Country:US
Practice Address - Phone:470-385-2201
Practice Address - Fax:678-324-1439
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2022-02-18
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant