Provider Demographics
NPI:1184314544
Name:JOHNSON, JOHRDAN (CLD CMHT)
Entity type:Individual
Prefix:
First Name:JOHRDAN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CLD CMHT
Other - Prefix:
Other - First Name:JOHRDAN
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4051 GOSHEN LAKE DR S
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-9113
Mailing Address - Country:US
Mailing Address - Phone:931-551-1171
Mailing Address - Fax:
Practice Address - Street 1:4051 GOSHEN LAKE DR S
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-9113
Practice Address - Country:US
Practice Address - Phone:931-551-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula