Provider Demographics
NPI:1710759980
Name:ALECHENDEM, JOHNSON (DNP, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JOHNSON
Middle Name:
Last Name:ALECHENDEM
Suffix:
Gender:M
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3649 BERMUDA CIR E
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-2603
Mailing Address - Country:US
Mailing Address - Phone:706-421-8292
Mailing Address - Fax:
Practice Address - Street 1:3649 BERMUDA CIR E
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2603
Practice Address - Country:US
Practice Address - Phone:706-421-8292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG176689363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty