Provider Demographics
NPI:1053605576
Name:AGBONA, GEANETTA JOHNSON (CPC, CPC-I, CBCS)
Entity type:Individual
Prefix:MRS
First Name:GEANETTA
Middle Name:JOHNSON
Last Name:AGBONA
Suffix:
Gender:F
Credentials:CPC, CPC-I, CBCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 MAKIN DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-7663
Mailing Address - Country:US
Mailing Address - Phone:704-254-7900
Mailing Address - Fax:
Practice Address - Street 1:2020 MAKIN DR
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-7663
Practice Address - Country:US
Practice Address - Phone:704-254-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00102028390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program