Provider Demographics
NPI:1942752076
Name:JOHNSON, CHARITA MONICA (APRN)
Entity Type:Individual
Prefix:DR
First Name:CHARITA
Middle Name:MONICA
Last Name:JOHNSON
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Gender:F
Credentials:APRN
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Mailing Address - Street 1:1624 MAIN STREET
Mailing Address - Street 2:AGAPE SENIOR PRIMARY CARE, INC., DBA LTC HEALTH SOLUTIO
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:803-726-2350
Mailing Address - Fax:803-404-6000
Practice Address - Street 1:1317 EBENEZER RD
Practice Address - Street 2:LTC HEALTH SOLUTIONS
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732
Practice Address - Country:US
Practice Address - Phone:803-207-8200
Practice Address - Fax:803-207-8207
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2019-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC20548363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily