Provider Demographics
NPI:1083132278
Name:JOHNSON, LAJUANNA
Entity Type:Individual
Prefix:
First Name:LAJUANNA
Middle Name:
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 1:1602 BEL AIR CIR
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-1396
Mailing Address - Country:US
Mailing Address - Phone:912-592-0661
Mailing Address - Fax:
Practice Address - Street 1:1602 BEL AIR CIR
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-1396
Practice Address - Country:US
Practice Address - Phone:912-592-0661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor