Provider Demographics
NPI:1962258301
Name:JOHNSON, LANEY (CPNP-PC)
Entity type:Individual
Prefix:
First Name:LANEY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7027 FENWICK ST
Mailing Address - Street 2:
Mailing Address - City:GRANITEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29829-4076
Mailing Address - Country:US
Mailing Address - Phone:478-290-7834
Mailing Address - Fax:
Practice Address - Street 1:2315 CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6246
Practice Address - Country:US
Practice Address - Phone:706-792-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP002240363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics