Healthcare Provider Details

I. General information

NPI: 1508331505
Provider Name (Legal Business Name): JOHNNA S ABBASI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E GIRARD AVE
CEDARTOWN GA
30125-2712
US

IV. Provider business mailing address

200 W MARTIN LUTHER KING BLVD STE 1000
CHATTANOOGA TN
37402-2571
US

V. Phone/Fax

Practice location:
  • Phone: 678-246-5174
  • Fax: 678-901-3336
Mailing address:
  • Phone: 423-269-2255
  • Fax: 888-698-8617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24762
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN202374
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: