Provider Demographics
NPI:1962877506
Name:JOHNSON, LESLIE J (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:JERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2081 NEWNAN CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265
Mailing Address - Country:US
Mailing Address - Phone:470-592-5505
Mailing Address - Fax:
Practice Address - Street 1:2081 NEWNAN CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265
Practice Address - Country:US
Practice Address - Phone:470-592-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN203517363LF0000X
NC5008205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1083738645Medicaid
NC1265556823OtherCIGNA
NC02BAUOtherBCBS
NC1265556823OtherUNITED