Provider Demographics
NPI:1386770196
Name:JOHNSON, TONJA T (MD)
Entity type:Individual
Prefix:
First Name:TONJA
Middle Name:T
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23110 STATE ROAD 54 # 367
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-6933
Mailing Address - Country:US
Mailing Address - Phone:813-527-3612
Mailing Address - Fax:
Practice Address - Street 1:715 PEACHTREE ST NE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2179
Practice Address - Country:US
Practice Address - Phone:212-369-6757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1051922084A0401X
AZ344002084P0800X
GA576702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ34400OtherLICENSE
AZ34400OtherLICENSE