Provider Demographics
NPI:1487858650
Name:JOHNSON, ANGELA DAWN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DAWN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2383 THIRD ST
Mailing Address - Street 2:
Mailing Address - City:FOLKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31537-8917
Mailing Address - Country:US
Mailing Address - Phone:912-496-4478
Mailing Address - Fax:912-496-1139
Practice Address - Street 1:2383 THIRD ST
Practice Address - Street 2:
Practice Address - City:FOLKSTON
Practice Address - State:GA
Practice Address - Zip Code:31537-8917
Practice Address - Country:US
Practice Address - Phone:912-496-4478
Practice Address - Fax:912-496-1139
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN113824NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA167741799DMedicaid
GA167741799DMedicaid
GA20250I0526Medicare PIN