Provider Demographics
NPI:1578573762
Name:JOHNSON, CHRISTY R (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 DEER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-6549
Mailing Address - Country:US
Mailing Address - Phone:478-994-8581
Mailing Address - Fax:
Practice Address - Street 1:657 HEMLOCK ST
Practice Address - Street 2:SUITE 220
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8329
Practice Address - Country:US
Practice Address - Phone:478-741-7241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN052724363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA383672674AMedicaid
GA383672674AMedicaid