Healthcare Provider Details

I. General information

NPI: 1093127250
Provider Name (Legal Business Name): TOCCARA JOHNSON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 VETERANS BLVD
DUBLIN GA
31021-3620
US

IV. Provider business mailing address

7324 QUAIL RUN RD
LIZELLA GA
31052-3758
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-1210
  • Fax: 478-274-5625
Mailing address:
  • Phone: 478-321-4698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number236011
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number236011
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: