Active NPI
Tarran John Johnson III
- Physical Therapist
- Stockbridge, GA
National Provider Identifier
1205098415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT005576
- Practice address
- 1133 Eagles Landing Pkwy
Stockbridge, GA 30281-5085 - Phone
- (678) 604-6435
- Fax
- (678) 604-5589
- NPI assigned
- Jun 28, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT005576 | GA | Primary |
Addresses
Primary practice location
1133 Eagles Landing Pkwy
Stockbridge, GA 30281-5085
Mailing address
1133 Eagles Landing Pkwy
Stockbridge, GA 30281-5085
Phone (678) 604-6435
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 897975292A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT005576 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214611200000",
"number": "1205098415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1133 EAGLES LANDING PKWY",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "302815085",
"telephone_number": "678-604-6435",
"fax_number": "678-604-5589"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1133 EAGLES LANDING PKWY",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "302815085",
"telephone_number": "678-604-6435",
"fax_number": "678-604-5589"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "TARRAN",
"middle_name": "JOHN",
"name_suffix": "III",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-28",
"last_updated": "2008-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT005576",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "897975292A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stockbridge, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.