Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | GA |
NPI | 1518517499 |
---|---|
Provider Name | Shanika Johnson |
First Address | Lawrenceville, GA 30043-6516 |
Second Address | Lawrenceville, GA 30043-6516 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2019 |
Last Update Date | 12/09/2019 |