Healthcare Provider Details

I. General information

NPI: 1437819893
Provider Name (Legal Business Name): HOLLI B JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 HWY 119 S
SPRINGFIELD GA
31329-3014
US

IV. Provider business mailing address

PO BOX 350
SPRINGFIELD GA
31329-0350
US

V. Phone/Fax

Practice location:
  • Phone: 912-754-6484
  • Fax: 912-754-7623
Mailing address:
  • Phone: 912-754-6484
  • Fax: 912-754-7623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN229012
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: