Individual
GEORGIA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
12809 CORLETT AVE, CLEVELAND, OH 44105-2915
(216) 456-4208
Mailing address
12809 CORLETT AVE, CLEVELAND, OH 44105-2915
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
168809
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168809
—
OH
Enumeration date
10/29/2021
Last updated
10/29/2021
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