Most Relevant Information
Provider Data
| NPI Number: | 1003313727 |
| Provider Name: | MICHAEL OLTON JOHNSON PA |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 11074 |
Most Important Dates
| Enumeration Date: | 04/09/2018 |
| Last Updated: | 05/09/2023 |
Provider Practice Location
377 W PIKE ST # A3-2
LAWRENCEVILLE
GA
300464881
Practice Location Phone/Fax
| Phone: | 4704617031 |
| Fax: | 7705026820 |
Provider Mailing Location
377 W PIKE ST # A3-2
LAWRENCEVILLE
GA
300464881
Provider Mailing Phone/Fax
| Phone: | 4704617031 |
| Fax: | 7705026820 |