Individual
MISS KELLI SHA'RON JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3014 BORING RIDGE DR, DECATUR, GA 30034-4427
(678) 907-2193
(678) 705-5435
Mailing address
3014 BORING RIDGE DR, DECATUR, GA 30034-4427
(678) 907-2193
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN068141
GA
Other
Enumeration date
01/02/2017
Last updated
01/02/2017
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