Provider Demographics
NPI:1659873644
Name:JOHNSON, AMBER MICHELE (FNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MICHELE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 PETTITS LN
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-4001
Mailing Address - Country:US
Mailing Address - Phone:706-254-1552
Mailing Address - Fax:
Practice Address - Street 1:830 KING AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2838
Practice Address - Country:US
Practice Address - Phone:706-425-2400
Practice Address - Fax:706-425-2410
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA217661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily