Provider Demographics
NPI:1962699850
Name:JOHNSON, CARRIE (PHARMD, BCPS, BCACP)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD, BCPS, BCACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 CASCADE PKWY SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-3090
Mailing Address - Country:US
Mailing Address - Phone:404-505-4039
Mailing Address - Fax:
Practice Address - Street 1:1175 CASCADE PKWY SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-3090
Practice Address - Country:US
Practice Address - Phone:404-505-4039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43019183500000X
GARPH0254541835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist