Provider Demographics
NPI:1659461028
Name:JOHNSON, SHIRLEE T (RN)
Entity type:Individual
Prefix:
First Name:SHIRLEE
Middle Name:T
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17221 GA HIGHWAY 242 W
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:GA
Mailing Address - Zip Code:30413-2607
Mailing Address - Country:US
Mailing Address - Phone:478-364-6132
Mailing Address - Fax:
Practice Address - Street 1:2501HIGHWAY 1 N
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:GA
Practice Address - Zip Code:30434
Practice Address - Country:US
Practice Address - Phone:478-625-3716
Practice Address - Fax:478-625-8201
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN030916163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health