MEDICARE: CAMELA ANN JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	CN0000028549	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CN0000028549	OTHER	GA	CERTIFIED NURSING AIDE

General Provider Information

NPI Number	:	1336742923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMELA ANN JOHNSON

Provider Business Mailing Address
First Line	:	3340 WALDROP TRL
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-7425
Country	:	US
Telephone Number	:	404-453-9907
Fax Number	:

Provider Business Practice Location Address
First Line	:	3340 WALDROP TRL
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-7425
Country	:	US
Telephone Number	:	404-453-9907
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	11/17/2020

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