Individual
ETHNEY LETETIA JOHNSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
2385 CHAMBLEE TUCKER RD, CHAMBLEE, GA 30341-3446
(678) 530-6012
(678) 530-6130
Mailing address
793 SHADOW LAKES DR, LITHONIA, GA 30058-6298
(770) 498-5917
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
RN111272
GA
Other
Enumeration date
01/06/2006
Last updated
07/08/2007
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