Provider Demographics
NPI:1225697873
Name:JOHNSTON, TAHIRAH (LPN)
Entity Type:Individual
Prefix:
First Name:TAHIRAH
Middle Name:
Last Name:JOHNSTON
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 1:289 JONESBORO RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3725
Mailing Address - Country:US
Mailing Address - Phone:800-760-0089
Mailing Address - Fax:
Practice Address - Street 1:1657 HALLMARK HILLS DR
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-8790
Practice Address - Country:US
Practice Address - Phone:800-760-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home