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General NPI Number Information
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NPI Number | 1023830593
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Entity Type | Individual
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Provider Name | MARIAH JOHNSON RN
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Gender | Female
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 1640 POWERS FERRY RD SE UNIT 300
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City | MARIETTA
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State | GA
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Zip | 30067-5491
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Country | US
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Telephone | 877-711-3418
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Fax |
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Provider Business Mailing Address
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Address Line | 7 EXECUTIVE PARK DR NE
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City | ATLANTA
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State | GA
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Zip | 30329-2250
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Country | US
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Telephone | 470-439-4420
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN322977
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License Number State | GA
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