Provider Demographics
NPI:1801351853
Name:JOHNSON, YOLONDA TANIKA
Entity type:Individual
Prefix:
First Name:YOLONDA
Middle Name:TANIKA
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 1:111 CYPRESS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-1671
Mailing Address - Country:US
Mailing Address - Phone:229-326-6976
Mailing Address - Fax:
Practice Address - Street 1:1411 TIFT AVE N STE A
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4625
Practice Address - Country:US
Practice Address - Phone:229-472-1788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty