Provider Demographics
NPI:1386869410
Name:JOHNSON, ALTEE S (MD)
Entity type:Individual
Prefix:
First Name:ALTEE
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:101 YORKTOWN DR
Mailing Address - Street 2:SUITE110
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1578
Mailing Address - Country:US
Mailing Address - Phone:678-364-5400
Mailing Address - Fax:678-364-5399
Practice Address - Street 1:101 YORKTOWN DR
Practice Address - Street 2:SUITE110
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1578
Practice Address - Country:US
Practice Address - Phone:678-364-5400
Practice Address - Fax:678-364-5399
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2016-01-06
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Provider Licenses
StateLicense IDTaxonomies
GA60387207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA060387OtherGEORGIA MEDICAL LICENSE