Healthcare Provider Details

I. General information

NPI: 1235824244
Provider Name (Legal Business Name): JAMIE LAKE JOHNSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 07/16/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 EAST HOSPITAL ROAD
AUGUSTA GA
30905-5950
US

IV. Provider business mailing address

300 EAST HOSPITAL ROAD
FORT GORDON GA
30905-5950
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-9007
  • Fax: 706-787-8131
Mailing address:
  • Phone: 706-787-9007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH025523
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH025523
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: