Individual
TANIKA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12 FITZWATER RD, PORT WENTWORTH, GA 31407-6017
(404) 457-4440
Mailing address
12 FITZWATER RD, PORT WENTWORTH, GA 31407-6017
(404) 457-4440
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/07/2022
Last updated
09/07/2022
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