Provider Demographics
NPI:1801990304
Name:FROST-JOHNSON, GENIEVE (NP)
Entity type:Individual
Prefix:
First Name:GENIEVE
Middle Name:
Last Name:FROST-JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1791 MULKEY ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1124
Mailing Address - Country:US
Mailing Address - Phone:770-941-6883
Mailing Address - Fax:770-941-7196
Practice Address - Street 1:1791 MULKEY ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1124
Practice Address - Country:US
Practice Address - Phone:770-941-6883
Practice Address - Fax:701-941-7196
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA165016363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA477271178BMedicaid
GA477271178BMedicaid