Provider Demographics
NPI:1396403937
Name:JOHNSON, MARJORIE ANN (RN, CCRN, CCM)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN, CCRN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 LINDQUIST RD
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5000
Mailing Address - Country:US
Mailing Address - Phone:912-435-5662
Mailing Address - Fax:912-435-5852
Practice Address - Street 1:192 LINDQUIST RD
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5000
Practice Address - Country:US
Practice Address - Phone:912-435-5662
Practice Address - Fax:912-435-5852
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN059108163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management