Provider Demographics
NPI:1114338761
Name:JOHNSON, JULIANE CODY (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JULIANE
Middle Name:CODY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:CODY
Other - Middle Name:WILLIAMS
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:41 EAST OGLETHORPE STREET
Mailing Address - Street 2:
Mailing Address - City:ELLAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31806
Mailing Address - Country:US
Mailing Address - Phone:229-937-9003
Mailing Address - Fax:229-937-9007
Practice Address - Street 1:41 EAST OGLETHORPE STREET
Practice Address - Street 2:
Practice Address - City:ELLAVILLE
Practice Address - State:GA
Practice Address - Zip Code:31806
Practice Address - Country:US
Practice Address - Phone:229-937-9003
Practice Address - Fax:229-937-9007
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA124320363LF0000X
GARN124320363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily