Provider Demographics
NPI:1841426707
Name:JOHNSON, KRISTINA NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3776 US HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-3378
Mailing Address - Country:US
Mailing Address - Phone:912-350-7020
Mailing Address - Fax:912-756-2427
Practice Address - Street 1:3776 US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3378
Practice Address - Country:US
Practice Address - Phone:912-350-7020
Practice Address - Fax:912-756-2427
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA068198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003125374DMedicaid
GA003125374AMedicaid
SCGA1347Medicaid
GAP01074147OtherRAILROAD MEDICARE
GA003125374FMedicaid
GA003125374BMedicaid
GA003125374CMedicaid
GA202I080019Medicare PIN
GA003125374AMedicaid