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Individual

MISS KWENDA KIKORA JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
535 N CENTRAL AVE, HAPEVILLE, GA 30354-1603
(404) 761-4040
Mailing address
5753 JUBILANT DR, REX, GA 30273-1574
(707) 656-6326

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-00351
NC
363AM0700X
Medical Physician Assistant
0010-00351
NC
363AM0700X
Medical Physician Assistant
Primary
13575
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0399PA
SC
01
1801811997
MEDICINE
GA
Enumeration date
07/12/2006
Last updated
01/26/2026
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