Healthcare Provider Details

I. General information

NPI: 1750402731
Provider Name (Legal Business Name): NIKKIA F. JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NIKKIA F. LAWRENCE MD

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 KENT RD STE 5
TIFTON GA
31794-1697
US

IV. Provider business mailing address

39 KENT RD STE 5
TIFTON GA
31794-1697
US

V. Phone/Fax

Practice location:
  • Phone: 229-353-7337
  • Fax: 229-391-4051
Mailing address:
  • Phone: 229-353-7337
  • Fax: 229-391-4051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number001278
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: