Individual
AMBROZINE OPHELIA TRENT-JOHNNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5910 HILLANDALE DR, SUITE 301, LITHONIA, GA 30058-1884
(678) 418-2120
(678) 418-2936
Mailing address
5910 HILLANDALE DR, SUITE 301, LITHONIA, GA 30058-1884
(678) 418-2120
(678) 418-2936
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004798
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004798
STATE LICENSE
GA
Enumeration date
02/19/2007
Last updated
07/08/2007
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