Provider Demographics
NPI:1528420452
Name:JOHNSON, SHAKIA (APRN)
Entity type:Individual
Prefix:
First Name:SHAKIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 POWERS FERRY RD SE STE E
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-7579
Mailing Address - Country:US
Mailing Address - Phone:770-726-2930
Mailing Address - Fax:404-602-0081
Practice Address - Street 1:1025 BULLSBORO DR STE A
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6800
Practice Address - Country:US
Practice Address - Phone:678-633-6841
Practice Address - Fax:770-502-2265
Is Sole Proprietor?:No
Enumeration Date:2016-03-21
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN195272363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner