Provider Demographics
NPI:1558998435
Name:JOHNSON, CELECHIA AVADAWNE
Entity Type:Individual
Prefix:MRS
First Name:CELECHIA
Middle Name:AVADAWNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CELECHIA
Other - Middle Name:AVADAWNE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3407 CHARTER CT
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6387
Mailing Address - Country:US
Mailing Address - Phone:770-483-6840
Mailing Address - Fax:
Practice Address - Street 1:3407 CHARTER CT
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6387
Practice Address - Country:US
Practice Address - Phone:770-483-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN199114163W00000X
GAF03200572363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care