Provider Demographics
NPI:1902320062
Name:JOHNSON, JERWANDA (FNP)
Entity Type:Individual
Prefix:
First Name:JERWANDA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 DEODAR LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-4919
Mailing Address - Country:US
Mailing Address - Phone:770-864-4253
Mailing Address - Fax:
Practice Address - Street 1:225 DEODAR LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-4919
Practice Address - Country:US
Practice Address - Phone:770-864-4253
Practice Address - Fax:770-864-4253
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN220008363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner