Provider Demographics
NPI:1285072231
Name:JOHNSON, MELONEY DENISE (RN)
Entity type:Individual
Prefix:MRS
First Name:MELONEY
Middle Name:DENISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 MAYWOOD DRIVE
Mailing Address - Street 2:OPTIONAL
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2272
Mailing Address - Country:US
Mailing Address - Phone:706-877-8042
Mailing Address - Fax:706-945-1697
Practice Address - Street 1:296 MAYWOOD DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-2272
Practice Address - Country:US
Practice Address - Phone:706-877-8042
Practice Address - Fax:706-945-1697
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN182512163WP0200X, 163WH0200X, 163WC0200X, 163WC2100X, 163WG0000X, 163WM0705X, 163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care