Provider Demographics
NPI:1295976017
Name:MIDDLEBROOKS, KIANA JOHNSON
Entity type:Individual
Prefix:MRS
First Name:KIANA
Middle Name:JOHNSON
Last Name:MIDDLEBROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2296
Mailing Address - Country:US
Mailing Address - Phone:706-354-7323
Mailing Address - Fax:706-354-7365
Practice Address - Street 1:1425 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2296
Practice Address - Country:US
Practice Address - Phone:706-354-7323
Practice Address - Fax:706-354-7365
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA230100102074141183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician