Provider Demographics
NPI:1851857684
Name:JOHNSON, JENICA (RDN, LDN)
Entity type:Individual
Prefix:MRS
First Name:JENICA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9018 OOLTEWAH GEORGETOWN RD STE 122
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-1515
Mailing Address - Country:US
Mailing Address - Phone:423-320-2565
Mailing Address - Fax:
Practice Address - Street 1:9018 OOLTEWAH GEORGETOWN RD STE 122
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-1515
Practice Address - Country:US
Practice Address - Phone:706-503-3850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004162133V00000X
AL2416133V00000X
SC2462133V00000X
TN2547133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered