Provider Demographics
NPI:1962201152
Name:JOHNSON, BEQUANDRA
Entity type:Individual
Prefix:
First Name:BEQUANDRA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 COBB PKWY SE STE 301
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3523
Mailing Address - Country:US
Mailing Address - Phone:470-930-6372
Mailing Address - Fax:
Practice Address - Street 1:1836 ROSWELL ST SE APT 10407
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2368
Practice Address - Country:US
Practice Address - Phone:470-930-6372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No174400000XOther Service ProvidersSpecialist