Healthcare Provider Details

I. General information

NPI: 1811851926
Provider Name (Legal Business Name): JILL CHRISTINE JOHNSON CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 SMITHVILLE CHURCH RD
WARNER ROBINS GA
31088-7802
US

IV. Provider business mailing address

208 SMITHVILLE CHURCH RD
WARNER ROBINS GA
31088-7802
US

V. Phone/Fax

Practice location:
  • Phone: 478-333-2333
  • Fax: 478-285-4256
Mailing address:
  • Phone: 478-333-2333
  • Fax: 478-285-4256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP013857
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: