Provider Demographics
NPI:1841381498
Name:JOHNSON, VALENCIA (NURSE)
Entity Type:Individual
Prefix:
First Name:VALENCIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2981 CHURCH ST STE 214
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-4100
Mailing Address - Country:US
Mailing Address - Phone:404-763-1456
Mailing Address - Fax:404-763-4115
Practice Address - Street 1:2981 CHURCH ST STE 214
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-4100
Practice Address - Country:US
Practice Address - Phone:404-763-1456
Practice Address - Fax:404-763-4115
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0600250H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based