Individual
DENETRA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5095 MOUNT ZION PKWY, STOCKBRIDGE, GA 30281-7825
(401) 652-9787
(401) 652-9787
Mailing address
5095 MOUNT ZION PKWY, STOCKBRIDGE, GA 30281-7825
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
R865978
MS
363LF0000X
Family Nurse Practitioner
Primary
RN161105
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN161105
LICENSE
GA
Enumeration date
10/14/2015
Last updated
10/10/2025
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