1316545148 NPI number — ADRIAN JOHNSON RN

Table of content: ADRIAN JOHNSON RN (NPI 1316545148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316545148 NPI number — ADRIAN JOHNSON RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
ADRIAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
ADRIAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316545148
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 CHURCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARKS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31647-7415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-506-3717
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 GIDDENS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARKS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31647-7622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-506-3717
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WH0200X , with the licence number:  RN307560 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1316545148 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".