Christopher Clark Johnson
Individual provider Active NPI Driver · Fairmount, GA
NPI 1245987205 · NPPES record last updated Mar 9, 2022
Key facts
- NPI
- 1245987205
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- 057957208 (GA)
- Practice address
- 2448 Highway 411 SE
Fairmount, GA 30139-2914 - Phone
- (706) 263-0039
- NPI assigned
- Mar 9, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 057957208 | GA | MD | Driver |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hometown Transit Co. | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 057957208 | GA | Yes |
Addresses
Primary practice location
2448 Highway 411 SE
Fairmount, GA 30139-2914
Mailing address
2448 Highway 411 SE
Fairmount, GA 30139-2914
Phone (706) 263-0039
Other providers in Fairmount, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.