Provider Demographics
NPI:1679173116
Name:JOHNSON - MONTEITH, MICHELLE VERONE (NP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:VERONE
Last Name:JOHNSON - MONTEITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 FISCHER MARKETPLACE LN STE 100
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-3680
Mailing Address - Country:US
Mailing Address - Phone:678-633-3260
Mailing Address - Fax:
Practice Address - Street 1:105 FISCHER MARKETPLACE LN STE 100
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-3680
Practice Address - Country:US
Practice Address - Phone:678-633-3260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN163740207R00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine