Provider Demographics
NPI:1336938612
Name:JOHNSON, QUIANNA
Entity type:Individual
Prefix:
First Name:QUIANNA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 CACTUS COVE LN
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-3437
Mailing Address - Country:US
Mailing Address - Phone:917-676-9797
Mailing Address - Fax:
Practice Address - Street 1:5115 CACTUS COVE LN
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-3437
Practice Address - Country:US
Practice Address - Phone:917-676-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula