Provider Demographics
NPI:1811630544
Name:JOHNSON, KIANA YVETTE
Entity type:Individual
Prefix:
First Name:KIANA
Middle Name:YVETTE
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 1:1441 WOODMONT LN NW STE 160
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2866
Mailing Address - Country:US
Mailing Address - Phone:943-888-1824
Mailing Address - Fax:833-563-2343
Practice Address - Street 1:511 ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-5201
Practice Address - Country:US
Practice Address - Phone:943-888-1824
Practice Address - Fax:833-563-2343
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9505350163W00000X
GAGAA-NP001722363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse