Provider Demographics
NPI:1760788988
Name:JOHNSON, ELIZABETH ELAINE (CLD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ELAINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4197 HIDEAWAY DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7804
Mailing Address - Country:US
Mailing Address - Phone:770-862-7868
Mailing Address - Fax:
Practice Address - Street 1:4197 HIDEAWAY DR
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7804
Practice Address - Country:US
Practice Address - Phone:770-862-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator