Healthcare Provider Details

I. General information

NPI: 1316545148
Provider Name (Legal Business Name): ADRIAN JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ADRIAN JOHNSON RN

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 GIDDENS LN
SPARKS GA
31647-7622
US

IV. Provider business mailing address

115 CHURCH ST
SPARKS GA
31647-7415
US

V. Phone/Fax

Practice location:
  • Phone: 229-506-3717
  • Fax:
Mailing address:
  • Phone: 229-506-3717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN307560
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: