Provider Demographics
NPI:1063645497
Name:DENT-JOHNSON, LOWANDA (PHD, CANP)
Entity Type:Individual
Prefix:DR
First Name:LOWANDA
Middle Name:
Last Name:DENT-JOHNSON
Suffix:
Gender:F
Credentials:PHD, CANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6859
Mailing Address - Country:US
Mailing Address - Phone:706-653-2255
Mailing Address - Fax:706-653-2329
Practice Address - Street 1:4519 WOODRUFF RD
Practice Address - Street 2:SUITE 4 PMB 349
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6011
Practice Address - Country:US
Practice Address - Phone:706-653-2255
Practice Address - Fax:706-653-2329
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN055775363L00000X
GARN055775 NP163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN055775 NPOtherGEORGIA LICENSE # RN055775 NP