Individual provider Active NPI

Cameron Johnson

  • Physical Therapist
  • Evans, GA
National Provider Identifier
1235823212
Registry record updated Jun 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
415 Town Park Blvd
Evans, GA 30809-3487
Phone
(706) 868-1707
NPI assigned
Jun 5, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

415 Town Park Blvd
Evans, GA 30809-3487

Mailing address

415 Town Park Blvd
Evans, GA 30809-3487

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230612001011 GA Practitioner - Physical Therapist in Private Practice 3476910126 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Evans Rehabilitation Services, LLCGroup PAC ID 2769467034, 20 clinicians

Practice addresses (Care Compare)

415 Town Park Blvd
Evans, GA 30809-3487
Phone (706) 868-1707

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT017256GAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Resurgens, LLC CurrentSince Sep 1, 2024 Accepting new patients
Evans Rehabilitation Services, LLC Physical Therapist CurrentSince May 25, 2023 Accepting new patients
Resurgens, LLC CurrentSince Sep 1, 2024 Accepting new patients

Locations

2115 Windsor Spring Rd
Ste 2300
Augusta, GA 30906

2115 Windsor Spring Rd
Ste 23
Augusta, GA 30906
Phone (706) 793-6211

2041 Mesa Valley Way
Ste 100
Austell, GA 30106
Phone (770) 944-1100

415 Town Park Blvd
Evans, GA 30809
Phone (706) 690-4372

5003 Steiner Way
Ste 2
Grovetown, GA 30813

156 Foster Dr
Ste B
McDonough, GA 30253
Phone (770) 506-4119

5671 Ptree Dunwoody Rd NE
Ste 900
Sandy Springs, GA 30342
Phone (404) 531-8590

5671 Ptree Dunwoody Rd NE
Ste 700
Sandy Springs, GA 30342
Phone (404) 459-3732

150 Main St
Thomson, GA 30824
Phone (706) 595-1090

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1685923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685923200000",
    "number": "1235823212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 TOWN PARK BLVD",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308093487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 TOWN PARK BLVD",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308093487",
            "telephone_number": "706-868-1707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "CAMERON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-05",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evans, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.