Healthcare Provider Details

I. General information

NPI: 1811319296
Provider Name (Legal Business Name): MRS. KRISTEN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2014
Last Update Date: 01/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3454 NEW FAWN LN
MILTON GA
30004-4438
US

IV. Provider business mailing address

3454 NEW FAWN LN
MILTON GA
30004-4438
US

V. Phone/Fax

Practice location:
  • Phone: 404-790-0080
  • Fax:
Mailing address:
  • Phone: 404-790-0080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: