Basic Information
| Provider Information | |||||||||
| NPI: | 1841961307 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | SAVANNAH | ||||||||
| MiddleName: | CLAY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP, APRN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 315 W PONCE DE LEON AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300302441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4045372521 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 315 W PONCE DE LEON AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300302441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4045372521 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2021 | ||||||||
| LastUpdateDate: | 05/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN305851 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.