Provider Demographics
NPI:1770940538
Name:JOHNSON, KATURAH LATAVIA
Entity type:Individual
Prefix:
First Name:KATURAH
Middle Name:LATAVIA
Last Name:JOHNSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3247 HIDEAWAY LN
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-7989
Mailing Address - Country:US
Mailing Address - Phone:404-432-8577
Mailing Address - Fax:
Practice Address - Street 1:4306 N SHALLOWFORD RD APT 2212
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-1158
Practice Address - Country:US
Practice Address - Phone:404-432-8577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0363LA2100X
GARN217948363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care