Candace J Johnson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

50389 Issued in GA

Practice address

225 Country Club Dr Ste 200
Stockbridge, GA 30281-7302

Phone

(678) 782-7137

Fax

(678) 782-7135

NPI assigned

Nov 23, 2005

Last updated

Jan 3, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Pediatric Medicine

Education

Medical College of Ohio, 1998

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956

  Pediatrics

  Medicare reassignment NPD
• CJ Pediatrics LLC

  • Pediatrics Physician
  • Stockbridge, GA
  • NPI 1477966380
  NPD (past)

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

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609632000000",
    "number": "1730162702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 COUNTRY CLUB DR STE 200",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817302",
            "telephone_number": "678-782-7137",
            "fax_number": "678-782-7135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 COUNTRY CLUB DR STE 200",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817302",
            "telephone_number": "678-782-7137",
            "fax_number": "678-782-7135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "CANDACE",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-23",
        "last_updated": "2021-01-03",
        "certification_date": "2021-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "50389",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000917782C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• JLM Dentistry of Stockbridge
• Lee C Joassin
• John C.Vencill O.D., P.C.
• Tamika Johnnicans, NURSE PRACTITIONER
• C J Johnson, PSYD
• Candice Johnson
• Charla V Johnson, PA-C
• Courtney Nicole Johnson, D.P.T.
• Denetra Johnson
• Jamia Joy Johnson

• Pediatrics Physician in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 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.