Healthcare Provider Details

I. General information

NPI: 1811630544
Provider Name (Legal Business Name): KIANA YVETTE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 ACADEMY AVE
DUBLIN GA
31021-5201
US

IV. Provider business mailing address

1441 WOODMONT LN NW STE 160
ATLANTA GA
30318-2866
US

V. Phone/Fax

Practice location:
  • Phone: 943-888-1824
  • Fax: 833-563-2343
Mailing address:
  • Phone: 943-888-1824
  • Fax: 833-563-2343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberGAA-NP001722
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5022444
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9505350
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: