Provider Demographics
NPI:1144050055
Name:JOHNSON, SHERLONDA EVETTE (RN)
Entity type:Individual
Prefix:
First Name:SHERLONDA
Middle Name:EVETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WRIGHT ST SE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-4424
Mailing Address - Country:US
Mailing Address - Phone:478-457-7664
Mailing Address - Fax:
Practice Address - Street 1:117 WRIGHT ST SE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-4424
Practice Address - Country:US
Practice Address - Phone:478-457-7664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC360839163W00000X
172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No163W00000XNursing Service ProvidersRegistered Nurse