Provider Demographics
NPI:1588485213
Name:JOHNSTON, ERIKA NICOLE
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:NICOLE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 FLOWERY BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4247
Mailing Address - Country:US
Mailing Address - Phone:770-845-6927
Mailing Address - Fax:
Practice Address - Street 1:2140 FLOWERY BRANCH RD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4247
Practice Address - Country:US
Practice Address - Phone:770-845-6927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP037188A225200000X
GAPTA005284225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant