Provider Demographics
NPI:1407835465
Name:JOHNSON, LAURIE G (MSN)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:G
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:GARFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:770-496-9400
Mailing Address - Fax:770-496-9495
Practice Address - Street 1:308 COLISEUM DR
Practice Address - Street 2:SUITE 120
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3808
Practice Address - Country:US
Practice Address - Phone:770-496-9400
Practice Address - Fax:770-496-9495
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN101726363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA103763417AMedicaid
GA50BBBGXVMedicare PIN
GA103763417AMedicaid