Provider Demographics
NPI:1811544133
Name:JOHNSON, CRISTINA LANAE
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:LANAE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 MILLER DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3229
Mailing Address - Country:US
Mailing Address - Phone:678-353-7844
Mailing Address - Fax:
Practice Address - Street 1:621 MILLER DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3229
Practice Address - Country:US
Practice Address - Phone:678-353-7844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program