Healthcare Provider Details

I. General information

NPI: 1497568919
Provider Name (Legal Business Name): ALISHA SHARVAE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 TERRELL MILL ROAD SE BLDG 1478, STE 100
MARIETTA GA
30067-5496
US

IV. Provider business mailing address

1355 TERRELL MILL RD SE STE 100
MARIETTA GA
30067-5496
US

V. Phone/Fax

Practice location:
  • Phone: 678-620-7717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberAPRN-NP317673
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: