Provider Demographics
NPI:1053066811
Name:JOHNSON, ERICA L
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 BEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:GA
Mailing Address - Zip Code:30646-3716
Mailing Address - Country:US
Mailing Address - Phone:678-488-3793
Mailing Address - Fax:
Practice Address - Street 1:443 BEDFORD DR
Practice Address - Street 2:
Practice Address - City:HULL
Practice Address - State:GA
Practice Address - Zip Code:30646-3716
Practice Address - Country:US
Practice Address - Phone:678-488-3793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-19
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health