Provider Demographics
NPI:1770463937
Name:JOHNSON, MONNESSIA LATREAL
Entity type:Individual
Prefix:
First Name:MONNESSIA
Middle Name:LATREAL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6175 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30830-2911
Mailing Address - Country:US
Mailing Address - Phone:706-360-0398
Mailing Address - Fax:
Practice Address - Street 1:6175 RIVER RD
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-2911
Practice Address - Country:US
Practice Address - Phone:706-360-0398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-06
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy