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Individual

DERQUIS JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP-C

Contact information

Practice address
4120 FIVE FORKS TRICKUM RD SW STE 104, LILBURN, GA 30047-8975
(770) 921-6900
Mailing address
4120 FIVE FORKS TRICKUM RD SW STE 104, LILBURN, GA 30047-8975

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
250545
GA

Other

Enumeration date
09/12/2022
Last updated
09/13/2025
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