Healthcare Provider Details

I. General information

NPI: 1013963024
Provider Name (Legal Business Name): CLAUDIA VICTORIA CANO JOHNSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 04/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2739 FELTON DR
EAST POINT GA
30344-3603
US

IV. Provider business mailing address

1639 ACADEMY SQ
COLLEGE PARK GA
30337-1404
US

V. Phone/Fax

Practice location:
  • Phone: 404-766-8371
  • Fax: 404-767-3926
Mailing address:
  • Phone: 404-766-2949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN135756
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: