{
"Npi": {
"NPI": "1558998435",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JOHNSON",
"FirstName": "CELECHIA",
"MiddleName": "AVADAWNE",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BROWN",
"OtherFirstName": "CELECHIA",
"OtherMiddleName": "AVADAWNE",
"OtherNamePrefix": "MISS",
"OtherNameSuffix": null,
"OtherCredential": "FNP",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "3407 CHARTER CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CONYERS",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30013-6387",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "770-483-6840",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2258 NORTHLAKE PKWY STE 365",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TUCKER",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30084-4019",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "470-357-2289",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/23/2020",
"LastUpdateDate": "09/09/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "F03200572",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "RN199114",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP2300X",
"TaxonomyName": "Primary Care Nurse Practitioner",
"LicenseNumber": "F03200572",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}