Healthcare Provider Details

I. General information

NPI: 1043076235
Provider Name (Legal Business Name): GEORGINA MILLICENT JULIOUS JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 SPEARS CREEK CHURCH RD
ELGIN SC
29045-8446
US

IV. Provider business mailing address

801 N BRICKYARD RD
COLUMBIA SC
29223-8227
US

V. Phone/Fax

Practice location:
  • Phone: 803-427-3231
  • Fax:
Mailing address:
  • Phone: 803-427-3231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number29517
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: