Provider Demographics
NPI:1841169018
Name:JOHNSON, SYDNEY GRACE (CAA)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:GRACE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18226 WHITETAIL LN
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-8630
Mailing Address - Country:US
Mailing Address - Phone:251-656-8007
Mailing Address - Fax:
Practice Address - Street 1:460 LANIER RD STE 100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2632
Practice Address - Country:US
Practice Address - Phone:256-319-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-04
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant