Individual provider Active NPI

Johnson O Palmer, NP-C

  • Family Nurse Practitioner
  • Buford, GA
National Provider Identifier
1154028454
Registry record updated Feb 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F10190787 Issued in GA
Practice address
1823 Hamilton Lake Pkwy
Buford, GA 30519-4765
Phone
(678) 791-2764
NPI assigned
Feb 8, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F10190787 GA Primary

Addresses

Primary practice location

1823 Hamilton Lake Pkwy
Buford, GA 30519-4765

Mailing address

1823 Hamilton Lake Pkwy
Buford, GA 30519-4765
Phone (678) 791-2764

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240116002727 GA Practitioner - Nurse Practitioner 6800248774 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Albany Medical College of Union University, 2019
Medicare assignment
May accept Medicare assignment
Group practices
Elina Healthcare IncGroup PAC ID 1153737408, 3 clinicians

Practice addresses (Care Compare)

4775 Jimmy Carter Blvd
Suite 201
Norcross, GA 30093-3760
Phone (470) 275-4911

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F10190787GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Elina Healthcare Inc CurrentSince Dec 4, 2023 Accepting new patients

Locations

4775 Jimmy Carter Blvd
Ste 201
Norcross, GA 30093
Phone (470) 275-4911

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1675814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675814400000",
    "number": "1154028454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1823 HAMILTON LAKE PKWY",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305194765",
            "telephone_number": "678-791-2764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1823 HAMILTON LAKE PKWY",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305194765",
            "telephone_number": "678-791-2764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALMER",
        "first_name": "JOHNSON",
        "middle_name": "O",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-02-08",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "F10190787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buford, GA

Sources for this page

Verify at the official NPI Registry.