Provider Demographics
NPI:1275237570
Name:JOHNSON, MCKENYA
Entity Type:Individual
Prefix:
First Name:MCKENYA
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 1:534 MCINTOSH RD APT C3
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:GA
Mailing Address - Zip Code:31305-9779
Mailing Address - Country:US
Mailing Address - Phone:912-506-2173
Mailing Address - Fax:
Practice Address - Street 1:108 E YORK ST STE 247
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-3719
Practice Address - Country:US
Practice Address - Phone:912-506-2173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician