Basic Information
| Provider Information | |||||||||
| NPI: | 1982181640 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNNICANS | ||||||||
| FirstName: | TAMIKA | ||||||||
| MiddleName: | |||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 145 EAGLES WALK STE A | ||||||||
| Address2: | |||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302817340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709141808 | ||||||||
| FaxNumber: | 7709146828 | ||||||||
| Practice Location | |||||||||
| Address1: | 145 EAGLES WALK STE A | ||||||||
| Address2: | |||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709141808 | ||||||||
| FaxNumber: | 7709146828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2018 | ||||||||
| LastUpdateDate: | 08/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN209553 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.