Lotus Family Wellness Clinic, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

LOTUS FAMILY WELLNESS CLINIC, LLC

Practice address

1240 Highway 138 SW
Riverdale, GA 30296-1402

Phone

(404) 668-1827

NPI assigned

Aug 17, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Qiana Aidah Johnson, DNP, FNP-C

Title

Owner/Family Nurse Practitioner

Phone

(404) 668-1827

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534464000000",
    "number": "1013497171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 BONNIE LN",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302158802",
            "telephone_number": "404-668-1827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 HIGHWAY 138 SW",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302961402",
            "telephone_number": "404-668-1827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOTUS FAMILY WELLNESS CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-17",
        "last_updated": "2018-08-17",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "QIANA",
        "authorized_official_middle_name": "AIDAH",
        "authorized_official_title_or_position": "OWNER/FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "404-668-1827",
        "authorized_official_credential": "DNP, FNP-C"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003151631F",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.