Provider Demographics
NPI:1447763594
Name:JOHNSON, CYNTHIA T (NP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:T
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 S MCKIBBEN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-2022
Mailing Address - Country:US
Mailing Address - Phone:678-603-0369
Mailing Address - Fax:
Practice Address - Street 1:152 S MCKIBBEN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-2022
Practice Address - Country:US
Practice Address - Phone:678-603-0369
Practice Address - Fax:678-603-0369
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-12
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN139146363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily