Provider Demographics
NPI:1437819893
Name:JOHNSON, HOLLI B (RN)
Entity Type:Individual
Prefix:
First Name:HOLLI
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:31329-0350
Mailing Address - Country:US
Mailing Address - Phone:912-754-6484
Mailing Address - Fax:912-754-7623
Practice Address - Street 1:802 HWY 119 S
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:GA
Practice Address - Zip Code:31329-3014
Practice Address - Country:US
Practice Address - Phone:912-754-6484
Practice Address - Fax:912-754-7623
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN229012163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse