Healthcare Provider Details

I. General information

NPI: 1841341500
Provider Name (Legal Business Name): TERESA W JOHNSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 NORTHSIDE DR
VALDOSTA GA
31602-1858
US

IV. Provider business mailing address

220 NORTHSIDE DR
VALDOSTA GA
31602-1858
US

V. Phone/Fax

Practice location:
  • Phone: 229-241-2800
  • Fax: 229-241-0454
Mailing address:
  • Phone: 229-241-2800
  • Fax: 229-241-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN078675
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number276718
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: