Provider Demographics
NPI:1902792179
Name:JOHNSON, CHANEL ANTIONETTE (NP)
Entity type:Individual
Prefix:MRS
First Name:CHANEL
Middle Name:ANTIONETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 SLEEPY HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-4251
Mailing Address - Country:US
Mailing Address - Phone:615-734-9690
Mailing Address - Fax:
Practice Address - Street 1:7330 SLEEPY HOLLOW CT
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-4251
Practice Address - Country:US
Practice Address - Phone:615-734-9690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN337845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily