Individual provider Active NPI

Mark Andrew Johnson, M.D.

  • Emergency Medicine Physician
  • East Point, GA
National Provider Identifier
1811375249
Registry record updated Aug 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
80598 Issued in GA
Practice address
1170 Cleveland Ave
East Point, GA 30344-3615
Phone
(404) 466-1600
NPI assigned
May 18, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 80598 GA Primary

Addresses

Primary practice location

1170 Cleveland Ave
East Point, GA 30344-3615

Mailing address

254 Trickum Creek Rd
Tyrone, GA 30290-1711
Phone (770) 876-5649

Other practice location 1

171 Ashley Ave
Charleston, SC 29425-8908
Phone (843) 792-2300

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20180919003614 GA Practitioner - Emergency Medicine 4082921051 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Mercer University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Acs Primary Care Physicians - Southeast PCGroup PAC ID 5193620714, 409 clinicians

Practice addresses (Care Compare)

200 Industrail Blvd
Dublin, GA 31021-2981
Phone (478) 275-2000

Hospital & facility affiliations

  • Fairview Park Hospital Hospital, Dublin, GA, CCN 110125

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
80598GAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Acs Primary Care Physicians - Southeast PC Emergency Medicine CurrentSince Aug 1, 2020 Accepting new patients
Lagrange Emergency Physicians, LLC Emergency Medicine CurrentSince Jul 23, 2018 Accepting new patients

Locations

303 Parkway Dr NE
Atlanta, GA 30312
Phone (404) 265-4000

200 Industrial Blvd
Dublin, GA 31021
Phone (478) 274-3865

1514 Vernon Rd
Lagrange, GA 30240
Phone (706) 812-2369

2151 W Spring St
Monroe, GA 30655
Phone (770) 267-1792

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1431907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533772800000",
    "number": "1811375249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "254 TRICKUM CREEK RD",
            "city": "TYRONE",
            "state": "GA",
            "postal_code": "302901711",
            "telephone_number": "770-876-5649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1170 CLEVELAND AVE",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303443615",
            "telephone_number": "404-466-1600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "171 Ashley Ave",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294258908",
            "country_code": "US",
            "telephone_number": "843-792-2300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARK",
        "middle_name": "ANDREW",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-18",
        "last_updated": "2018-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "80598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Point, GA

Sources for this page

Verify at the official NPI Registry.