Provider Demographics
NPI:1831254382
Name:JOHNSON-YOUNG, LATONJA Q (FNP)
Entity type:Individual
Prefix:MRS
First Name:LATONJA
Middle Name:Q
Last Name:JOHNSON-YOUNG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:LATONJA
Other - Middle Name:Q
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:770-495-3396
Mailing Address - Fax:770-495-2307
Practice Address - Street 1:624 W MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2787
Practice Address - Country:US
Practice Address - Phone:478-453-1806
Practice Address - Fax:478-453-1807
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN123293363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP96858Medicare UPIN
GA50BBKXXMedicare PIN