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NPI Code Detail

MEDICARE: LATREASIA JOHNSON

MEDICARE: LATREASIA 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
1164W00000XLicensed Practical NurseLPN085167GA

General Provider Information

NPI Number : 1639885387
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATREASIA JOHNSON
Provider Business Mailing Address
First Line : 1901 ELM PARK DR
Second Line :
City : HAMPTON
State : GA
Zip : 30228-5519
Country : US
Telephone Number : 478-737-5429
Fax Number :
Provider Business Practice Location Address
First Line : 1901 ELM PARK DR
Second Line :
City : HAMPTON
State : GA
Zip : 30228-5519
Country : US
Telephone Number : 478-737-5429
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2023
Last Update Date : 01/26/2023

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Directions to “ LATREASIA JOHNSON ” Practice Location

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