Provider Demographics
NPI:1154785335
Name:JOHNSON, JOAN STEPHANIE (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:STEPHANIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4834
Mailing Address - Country:US
Mailing Address - Phone:770-227-8636
Mailing Address - Fax:
Practice Address - Street 1:415 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4834
Practice Address - Country:US
Practice Address - Phone:770-227-8636
Practice Address - Fax:508-984-7220
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN297937363LP2300X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care