Individual
MS. JACQUELINE RUTH JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.DIV.
Contact information
Practice address
4425 MEMORIAL DR, DECATUR, GA 30032-1337
(404) 298-8383
Mailing address
764 WYNBROOKE PKWY, STONE MOUNTAIN, GA 30087-6322
(770) 469-1225
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
146319
GA
Other
Enumeration date
04/11/2007
Last updated
07/08/2007
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