Provider Demographics
NPI:1467575530
Name:JOHNSON, ADELINE JANINE (MD)
Entity Type:Individual
Prefix:DR
First Name:ADELINE
Middle Name:JANINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:902 PONDER PLACE CT
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3184
Mailing Address - Country:US
Mailing Address - Phone:706-922-3376
Mailing Address - Fax:706-922-5643
Practice Address - Street 1:902 PONDER PLACE CT
Practice Address - Street 2:1ST FLOOR
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3184
Practice Address - Country:US
Practice Address - Phone:706-922-3376
Practice Address - Fax:706-922-5643
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARTP001237207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology