Provider Demographics
NPI:1578946133
Name:PERRINE, JOHANA ANDREA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHANA
Middle Name:ANDREA
Last Name:PERRINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOHANA
Other - Middle Name:ANDREA
Other - Last Name:POLANCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5462 MEMORIAL DR STE 202
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3239
Mailing Address - Country:US
Mailing Address - Phone:404-292-5676
Mailing Address - Fax:
Practice Address - Street 1:5462 MEMORIAL DR STE 202
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3239
Practice Address - Country:US
Practice Address - Phone:404-292-5676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA77397207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine