Active NPI
Glen Johnson, MA
- Audiologist
- Toccoa, GA
National Provider Identifier
1891788980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 3575
- Practice address
- 274 Big a Road
Toccoa, GA 30577-6002 - Phone
- (706) 886-7412
- Fax
- (706) 886-1115
- NPI assigned
- Aug 24, 2005
- 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 |
|---|---|---|---|---|
| Audiologist | 231H00000X | 3575 | GA | Primary |
Addresses
Primary practice location
274 Big a Road
Toccoa, GA 30577-6002
Mailing address
274 Big a Road
Toccoa, GA 30577-6002
Phone (706) 886-7412
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000889908A | 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)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3575 | GA | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210291200000",
"number": "1891788980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "274 BIG A ROAD",
"city": "TOCCOA",
"state": "GA",
"postal_code": "305776002",
"telephone_number": "706-886-7412",
"fax_number": "706-886-1115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "274 BIG A ROAD",
"city": "TOCCOA",
"state": "GA",
"postal_code": "305776002",
"telephone_number": "706-886-7412",
"fax_number": "706-886-1115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "GLEN",
"credential": "MA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-24",
"last_updated": "2008-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "GA",
"license": "3575",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000889908A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Toccoa, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 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.