Provider Demographics
NPI:1972498186
Name:JOHNSON, MIESHA (CNA CMT)
Entity type:Individual
Prefix:
First Name:MIESHA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNA CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3372 PEACHTREE RD NE STE 115
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1963
Mailing Address - Country:US
Mailing Address - Phone:678-562-8003
Mailing Address - Fax:
Practice Address - Street 1:3372 PEACHTREE RD NE STE 115
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1963
Practice Address - Country:US
Practice Address - Phone:678-562-8003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO152265172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker