Individual
MR. LANCE M JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
541 HISTORIC HWY 441 N, DEMOREST, GA 30535
(706) 839-6205
(706) 754-9668
Mailing address
PO BOX 369, TURNERVILLE, GA 30580-0369
(706) 839-6205
(706) 754-9668
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R142266
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000819475B
—
GA
05
—
00819475A
—
GA
Enumeration date
07/20/2006
Last updated
10/11/2010
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