Healthcare Provider Details

I. General information

NPI: 1043456197
Provider Name (Legal Business Name): CHANEL SHELTON JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 12/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LAKE HEARN DR NE SUITE 450
ATLANTA GA
30342-1523
US

IV. Provider business mailing address

1100 LAKE HEARN DR NE SUITE 450
ATLANTA GA
30342-1523
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-7339
  • Fax: 404-257-0337
Mailing address:
  • Phone: 404-252-7339
  • Fax: 404-257-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN163332
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: