Provider Demographics
NPI:1255190120
Name:JOHNSON, SARAH KATELYN (LPN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KATELYN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:KATELYN
Other - Last Name:MCCANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:61 ROLLING WOODS LN
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:GA
Mailing Address - Zip Code:30646-4093
Mailing Address - Country:US
Mailing Address - Phone:678-672-0827
Mailing Address - Fax:
Practice Address - Street 1:240 MITCHELL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2043
Practice Address - Country:US
Practice Address - Phone:706-389-6789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN099243164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse