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Individual

CHERI K. JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
171 VILLAGE LAKE DR, POOLER, GA 31322-2147
(912) 349-5165
Mailing address
457 BUCKNER CIR, ANNISTON, AL 36205-4413
(912) 704-7367

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
003850
GA
363A00000X
Physician Assistant
Primary
PA.930
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0980PA
SC
05
100002280F
GA
05
100002280G
GA
01
582203199-004
HMHS TRICARE SOUTH - SAVANNAH
01
582203199-009
HMHS TRICARE SOUTH - POOLER
01
P00853761
RR MEDICARE
GA
Enumeration date
10/11/2006
Last updated
09/06/2016
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