Adeline Janine Johnson, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

RTP001237 Issued in GA

Practice address

902 Ponder Place CT
1St Floor
Evans, GA 30809-3184

Phone

(706) 922-3376

Fax

(706) 922-5643

NPI assigned

Apr 6, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226534400000",
    "number": "1467575530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 PONDER PLACE CT",
            "address_2": "1ST FLOOR",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308093184",
            "telephone_number": "706-922-3376",
            "fax_number": "706-922-5643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 PONDER PLACE CT",
            "address_2": "1ST FLOOR",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308093184",
            "telephone_number": "706-922-3376",
            "fax_number": "706-922-5643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ADELINE",
        "middle_name": "JANINE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-06",
        "last_updated": "2008-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "RTP001237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer L Moore, LMFT, LLC
• Heather Jennings, NP
• Kimberly Jennings, NURSE PRACTITIONER
• Jacqueline Marie Jeschke, DPT
• Christopher Ryan Jimenez, MD
• Cameron Johnson
• Kenneth Ray Johnson, PA-C
• Victor L Johnson, R.PH.
• William Kent Johnson, M.D.
• Laurie Denise Jolly

• Dermatology Physician in Evans, GA
• Providers in Evans, GA by specialty
• Dermatology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.