Provider Demographics
NPI:1972703593
Name:JOHNSON, DARLENE MACHELE (RN)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:MACHELE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:DARLENE
Other - Middle Name:MACHELE
Other - Last Name:MATHIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:214 WESTLAKE DR
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-9423
Mailing Address - Country:US
Mailing Address - Phone:478-240-9455
Mailing Address - Fax:
Practice Address - Street 1:610 SPARTA RD
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-1860
Practice Address - Country:US
Practice Address - Phone:478-240-2303
Practice Address - Fax:478-240-2388
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-21
Last Update Date:2007-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN164687163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical