Provider Demographics
NPI:1477870350
Name:JOHNSON, CHARLYNN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHARLYNN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 ENOCH BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-2231
Mailing Address - Country:US
Mailing Address - Phone:731-926-4222
Mailing Address - Fax:731-926-4228
Practice Address - Street 1:80 ENOCH BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-2231
Practice Address - Country:US
Practice Address - Phone:731-926-9600
Practice Address - Fax:731-926-9604
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14948363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily