Kathleen S Johnson, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

054906 Issued in GA

Practice address

1458 Church St Ste B
Decatur, GA 30030-1672

Phone

(404) 501-6027

Fax

(404) 377-0550

NPI assigned

Aug 30, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kathleen S Petty Professional name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Obstetrics/Gynecology

Education

University of Connecticut School of Medicine, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Julianne Adams Birt, MD, LLCGroup PAC ID 3971774571, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Piedmont Rockdale Hospital Hospital, Conyers, GA, CCN 110091
• Piedmont Newton Hospital Hospital, Covington, GA, CCN 110018
• Emory Hillandale Hospital Hospital, Lithonia, GA, CCN 110226

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Julianne Adams Birt, MD, LLC

  • Obstetrics & Gynecology Physician
  • Conyers, GA
  • NPI 1346538881
  Medicare reassignment Care Compare group NPD
• Obhg Georgia, P.C.

  • Obstetrics & Gynecology Physician
  • Athens, GA
  • NPI 1750686838
  Medicare reassignment NPD
• SGMC Physician Network Inc

  • Multi-Specialty Clinic/Center
  • Valdosta, GA
  • NPI 1417597170
  Medicare reassignment NPD
• Hospital Authority of Valdosta and Lowndes County Georgia

  • General Acute Care Hospital
  • Valdosta, GA
  • NPI 1306896253
  Medicare reassignment
• Hospital Authority of Valdosta and Lowndes County Georgia

  • Psychiatric Hospital Unit
  • Valdosta, GA
  • NPI 1033160791
  NPD
• Hospital Authority of Valdosta and Lowndes County, Georgia

  • Psychiatric Hospital Unit
  • Nashville, GA
  • NPI 1174864417
  NPD
• Hospital Authority of Valdosta and Lowndes County, Georgia

  • Ambulance
  • Valdosta, GA
  • NPI 1558141671
  NPD
• SGMC Affiliated Services LLC

  • Multi-Specialty Clinic/Center
  • Valdosta, GA
  • NPI 1114740362
  NPD
• Dekalb Women'S Specialists

  • Obstetrics & Gynecology Physician
  • Lithonia, GA
  • NPI 1275845893
  NPD (past)
• Dekalb Women'S Specialists

  • Obstetrics & Gynecology Physician
  • Stone Mountain, GA
  • NPI 1851604995
  NPD (past)
• Dekalb Women'S Specialists 2 LLC

  • Obstetrics & Gynecology Physician
  • Decatur, GA
  • NPI 1366572067
  NPD (past)
• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Dekalb Medical Center, Inc.

  • General Acute Care Hospital
  • Lithonia, GA
  • NPI 1962403865
  Care Compare affiliation
• Piedmont Newton Hospital, Inc.

  • General Acute Care Hospital
  • Covington, GA
  • NPI 1760498588
  Care Compare affiliation
• Piedmont Rockdale Hospital Inc.

  • General Acute Care Hospital
  • Conyers, GA
  • NPI 1306355680
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634256000000",
    "number": "1104819689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1458 CHURCH ST STE B",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300301672",
            "telephone_number": "404-508-5012",
            "fax_number": "404-508-5560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1458 CHURCH ST STE B",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300301672",
            "telephone_number": "404-501-6027",
            "fax_number": "404-377-0550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5295 Stone Mountain Hwy Ste N",
            "address_purpose": "LOCATION",
            "city": "Stone Mountain",
            "state": "GA",
            "postal_code": "300873439",
            "country_code": "US",
            "telephone_number": "404-508-2000",
            "fax_number": "404-377-0550",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8052 Mall Pkwy Ste 202",
            "address_purpose": "LOCATION",
            "city": "Lithonia",
            "state": "GA",
            "postal_code": "300382649",
            "country_code": "US",
            "telephone_number": "404-508-2000",
            "fax_number": "404-377-0550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KATHLEEN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-30",
        "last_updated": "2021-10-15",
        "certification_date": "2021-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "054906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1048971676AB",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHLEEN",
            "last_name": "PETTY",
            "middle_name": "S",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Janiya Johnson, BSN, RN
• Jermaine Johnson
• Jessica Johnson, MS, C.G.C.
• Karen Johnson, MSW, CACII, CAMSII
• Katerra Johnson
• Kelli Sha'Ron Johnson, LPN
• Kinesha Johnson
• Krystal Johnson, LPC
• Leonard Johnson, D.D.S.
• Maria Elizabeth Johnson, M.D.

• Obstetrics & Gynecology Physician in Decatur, GA
• Providers in Decatur, GA by specialty
• Obstetrics & Gynecology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.