Provider Demographics
NPI:1407099443
Name:JOHNSON, JUANITA O (CNM)
Entity Type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:O
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4700 BATTLEFILED PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-5168
Mailing Address - Country:US
Mailing Address - Phone:706-861-4508
Mailing Address - Fax:706-861-2696
Practice Address - Street 1:1829 GUNBARREL RD
Practice Address - Street 2:B-1
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7184
Practice Address - Country:US
Practice Address - Phone:706-861-4508
Practice Address - Fax:706-861-2696
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7492367A00000X
GAAPN0000007492367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife