Provider Demographics
NPI:1811377641
Name:JOHNSON, COURTNEY
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, RN
Mailing Address - Street 1:1040 ALEXANDER DR
Mailing Address - Street 2:APT 2324
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-0243
Mailing Address - Country:US
Mailing Address - Phone:302-562-4089
Mailing Address - Fax:
Practice Address - Street 1:1040 ALEXANDER DR
Practice Address - Street 2:APT 2324
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-0243
Practice Address - Country:US
Practice Address - Phone:302-562-4089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-06
Last Update Date:2015-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0031591163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse