Provider Demographics
NPI:1487025367
Name:JOHNSON, ERIN K (MPH, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MPH, RD, LD
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:LEIGH
Other - Last Name:KENDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1420 10TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-3008
Mailing Address - Country:US
Mailing Address - Phone:910-489-4655
Mailing Address - Fax:
Practice Address - Street 1:710 CENTER ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1527
Practice Address - Country:US
Practice Address - Phone:706-571-1156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004037133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered