Provider Demographics
NPI:1013963024
Name:CANO JOHNSON, CLAUDIA VICTORIA (NP)
Entity Type:Individual
Prefix:MRS
First Name:CLAUDIA
Middle Name:VICTORIA
Last Name:CANO 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 1:1639 ACADEMY SQ
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-1404
Mailing Address - Country:US
Mailing Address - Phone:404-766-2949
Mailing Address - Fax:
Practice Address - Street 1:2739 FELTON DR
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3603
Practice Address - Country:US
Practice Address - Phone:404-766-8371
Practice Address - Fax:404-767-3926
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN135756363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000972727AMedicaid