Provider Demographics
NPI:1104427269
Name:JOHNSON, KELLY MICHELE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MICHELE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:MICHELE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2772 W ELLIS RD
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-7000
Mailing Address - Country:US
Mailing Address - Phone:404-925-7847
Mailing Address - Fax:
Practice Address - Street 1:135 WILLOW LN
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6574
Practice Address - Country:US
Practice Address - Phone:404-925-7847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist