Provider Demographics
NPI:1316112188
Name:DEBORA STOREY JOHNSON, MD PC
Entity type:Organization
Organization Name:DEBORA STOREY JOHNSON, MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:STOREY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-699-9600
Mailing Address - Street 1:950 DANNON VW SW
Mailing Address - Street 2:SUITE 4101
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2160
Mailing Address - Country:US
Mailing Address - Phone:404-699-9600
Mailing Address - Fax:404-696-7100
Practice Address - Street 1:950 DANNON VW SW
Practice Address - Street 2:SUITE 4101
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2160
Practice Address - Country:US
Practice Address - Phone:404-699-9600
Practice Address - Fax:404-696-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0430712084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA070979307AMedicaid