Individual
WYNESHA DESIREE JOHNICAN-SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
584 N. MACON STREET, LUDOWICI, GA 31316
(912) 545-2107
(912) 545-2112
Mailing address
150 SCRANTON CONNECTOR, BRUNSWICK, GA 31525-0540
(912) 626-3063
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
RN315777
GA
163WP0808X
Psychiatric/Mental Health Registered Nurse
RN315777
GA
Other
Enumeration date
09/29/2023
Last updated
09/29/2023
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