Healthcare Provider Details

I. General information

NPI: 1083132021
Provider Name (Legal Business Name): SHEKITA JOHNSON CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 06/06/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 JESSE HILL JR DR SE
ATLANTA GA
30303-3032
US

IV. Provider business mailing address

35 JESSE HILL JR DR SE
ATLANTA GA
30303-3032
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-9650
  • Fax: 404-785-9870
Mailing address:
  • Phone: 404-785-9650
  • Fax: 404-785-9870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN225063
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: