Wynesha Desiree Johnican-Smith, RN
Individual provider Active NPI Community Health Registered Nurse · Ludowici, GA
NPI 1477333201 · NPPES record last updated Sep 29, 2023
Key facts
- NPI
- 1477333201
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Community Health Registered Nurse 163WC1500X
- License
- RN315777 (GA)
- Practice address
- 584 N. Macon Street
Ludowici, GA 31316 - Phone
- (912) 545-2107
- Fax
- (912) 545-2112
- NPI assigned
- Sep 29, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN315777 | GA | MD | Psychiatric/Mental Health Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Long County Board of Health | Current |
Accepting new patients |
Locations
150 Scranton Connector
Brunswick, GA 31525
Phone (912) 262-2300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | RN315777 | GA | |
| Community Health Registered Nurse | 163WC1500X | RN315777 | GA | Yes |
Addresses
Primary practice location
584 N. Macon Street
Ludowici, GA 31316
Mailing address
150 Scranton Connector
Brunswick, GA 31525-0540
Phone (912) 626-3063
Other providers in Ludowici, GA
- Stacie Graham
- Chelsey Guthrie
- Angela Elizabeth Hartley
- Consuela Maria Henry
- Hospital Authority of Liberty County
- Mary A. Lias
- Long County Board of Education
- Long County Board of Health
- Long County Health Center
- Ludowici Drugs
All providers in Ludowici, GA · Community Health Registered Nurse in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 29, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.