Provider Demographics
NPI:1720788201
Name:JOHNSON, SHARNESE
Entity Type:Individual
Prefix:
First Name:SHARNESE
Middle Name:
Last Name:JOHNSON
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 1:789 HAMMOND DR APT 1901
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-8156
Mailing Address - Country:US
Mailing Address - Phone:470-258-8114
Mailing Address - Fax:
Practice Address - Street 1:789 HAMMOND DR APT 1901
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-8156
Practice Address - Country:US
Practice Address - Phone:470-258-8114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)