| NPI | 1447687512 |
|---|---|
| Former Name | ANGELETTA MACHELLE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN116219) |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2023-07-12 |