Organization
LOTUS FAMILY WELLNESS CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
QIANA AIDAH JOHNSON DNP, FNP-C (OWNER/FAMILY NURSE PRACTITIONER)
(404) 668-1827
Entity
Organization
Contact information
Practice address
1240 HIGHWAY 138 SW, RIVERDALE, GA 30296-1402
(404) 668-1827
Mailing address
280 BONNIE LN, FAYETTEVILLE, GA 30215-8802
(404) 668-1827
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003151631F
—
GA
Enumeration date
08/17/2018
Last updated
08/17/2018
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