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General NPI Number Information
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NPI Number | 1588276505
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Entity Type | Individual
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Provider Name | SHERRON JOHNSON NP
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Gender | Male
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Dates
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Enumeration Date | 08/20/2020
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Last Update Date | 08/20/2020
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Provider Practice Location Address
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Address Line | 1980 WRIGHTS WAY
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City | JONESBORO
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State | GA
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Zip | 30236-7205
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Country | US
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Telephone | 770-367-6868
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 870321
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City | MORROW
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State | GA
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Zip | 30287-0321
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Country | US
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Telephone | 770-472-0011
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | RN204192
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License Number State | GA
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