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General NPI Number Information
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NPI Number | 1376535260
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Entity Type | Individual
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Provider Name | CHRISTINA MICHELLE JOHNSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 02/24/2014
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Provider Practice Location Address
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Address Line | 10055 FORD AVE STE 4A
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City | RICHMOND HILL
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State | GA
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Zip | 31324-3972
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Country | US
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Telephone | 912-756-3075
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Fax | 912-756-5291
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Provider Business Mailing Address
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Address Line | 10055 FORD AVE STE 4A
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City | RICHMOND HILL
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State | GA
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Zip | 31324-3972
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Country | US
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Telephone | 912-756-3075
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Fax | 912-756-5291
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1066586
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 006891
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License Number State | GA
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