Provider Demographics
NPI:1003394388
Name:JOHNS, SAMERAH (LPN)
Entity Type:Individual
Prefix:
First Name:SAMERAH
Middle Name:
Last Name:JOHNS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4697 WEHUNT COMMONS DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-7311
Mailing Address - Country:US
Mailing Address - Phone:901-871-6208
Mailing Address - Fax:
Practice Address - Street 1:4697 WEHUNT COMMONS DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-7311
Practice Address - Country:US
Practice Address - Phone:901-871-6208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN094072164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse