| Doctor Name: | MRS. ANDREA G JOHNSON |
| NPI Number: | 1679568174 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CSPOMM DO MB |
| License Number: | 5101009343 |
| Business Practice Address: | 2501 Jolly Rd Suite 120 Okemos, MI - 488643676 |
| Business Phone Number: | 5173810299 |
| Business Fax Number: | 5173819950 |
| Mailing Address: | 2501 Jolly Rd, Suite 120 OKEMOS |
| State: | MI |
| Postal Code: | 488643676 |
| Phone Number: | 5173810299 |
| Fax Number: | 5173819950 |
| NPI Enumeration Date: | 09/12/2005 |
| NPI Last Update Date: | 01/07/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 5101009343 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |