Priscilla Phan Johnson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

11803 Issued in GA

Practice address

1100 W Lake Commons Dr
Martinez, GA 30907-7932

Phone

(706) 250-6919

NPI assigned

Apr 26, 2017

Last updated

Dec 1, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA, SC2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Piedmont Professional Services LLCGroup PAC ID 8921176231, 171 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Piedmont Augusta Hospital Hospital, Augusta, GA, CCN 110028

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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

• Piedmont Professional Services, LLC

  • Nephrology Physician
  • Stockbridge, GA
  • NPI 1104088905

  SC

  Medicare reassignment Care Compare group
• Au Medical Associates Inc

  • Multi-Specialty Clinic/Center
  • Augusta, GA
  • NPI 1841230620
  Medicare reassignment
• Hospital Physician Services - Southeast Professional Corporation

  • Hospitalist Physician
  • Monroe, GA
  • NPI 1760410385
  Medicare reassignment
• Au Medical Associates Inc

  dba Augusta University Health West Wheeler

  • Durable Medical Equipment & Medical Supplies
  • Augusta, GA
  • NPI 1114574126
  NPD
• Piedmont Medical Care Corporation

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1912956046

  Family Medicine

  NPD (past)
• Pensacola Nephrology, PA

  dba Renalus Center for Kidney Care

  • Nephrology Physician
  • Fort Walton Beach, FL
  • NPI 1871535955
  NPD (past)
• Renal Care Group of the Southeast, Inc.

  dba Fresenius Medical Care Cordova

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Pensacola, FL
  • NPI 1356453195
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• University Health Services,Inc

  dba Piedmont Augusta Hospital

  • General Acute Care Hospital
  • Augusta, GA
  • NPI 1588665566
  Care Compare affiliation

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

{
    "created_epoch": "1493164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701388800000",
    "number": "1578098695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11037",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325241037",
            "telephone_number": "850-444-7000",
            "fax_number": "850-444-7497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 W LAKE COMMONS DR",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309077932",
            "telephone_number": "706-250-6919"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1619 Creighton Rd",
            "address_2": "Suite 1",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325047152",
            "country_code": "US",
            "telephone_number": "850-444-4700",
            "fax_number": "850-434-8144",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "319 Green Acres Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Fort Walton Beach",
            "state": "FL",
            "postal_code": "325471170",
            "country_code": "US",
            "telephone_number": "850-862-2385",
            "fax_number": "850-862-0482",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14114 Alabama St",
            "address_purpose": "LOCATION",
            "city": "Jay",
            "state": "FL",
            "postal_code": "325651219",
            "country_code": "US",
            "telephone_number": "850-444-4700",
            "fax_number": "850-434-8144",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "221 E Redstone Ave",
            "address_purpose": "LOCATION",
            "city": "Crestview",
            "state": "FL",
            "postal_code": "325395373",
            "country_code": "US",
            "telephone_number": "850-398-6606",
            "fax_number": "850-398-6424",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6001 Industrial Blvd",
            "address_purpose": "LOCATION",
            "city": "Century",
            "state": "FL",
            "postal_code": "325353312",
            "country_code": "US",
            "telephone_number": "850-444-4700",
            "fax_number": "850-434-8144",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5934 Berryhill Medical Park Dr # 1",
            "address_purpose": "LOCATION",
            "city": "Milton",
            "state": "FL",
            "postal_code": "32570",
            "country_code": "US",
            "telephone_number": "850-623-4771",
            "fax_number": "850-623-3938",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2583 Gulf Breeze Pkwy",
            "address_purpose": "LOCATION",
            "city": "Gulf Breeze",
            "state": "FL",
            "postal_code": "32563",
            "country_code": "US",
            "telephone_number": "850-444-4700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4304 Lancaster Dr",
            "address_purpose": "LOCATION",
            "city": "Niceville",
            "state": "FL",
            "postal_code": "325784563",
            "country_code": "US",
            "telephone_number": "850-862-2385",
            "fax_number": "850-862-0482",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5149 N 9th Ave Ste G35",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325048733",
            "country_code": "US",
            "telephone_number": "850-444-4700",
            "fax_number": "850-434-8144",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2940 N Blue Angel Pkwy",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325062925",
            "country_code": "US",
            "telephone_number": "850-444-4700",
            "fax_number": "850-434-8144",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1717 N E St Ste 403",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325016334",
            "country_code": "US",
            "telephone_number": "850-444-4700",
            "fax_number": "850-434-8144",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "PRISCILLA",
        "middle_name": "PHAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-26",
        "last_updated": "2023-12-01",
        "certification_date": "2023-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "11803",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9110351",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9110351",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "11803",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020947500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA STATE DOH MEDICAL LICENSURE",
            "identifier": "PA9110351",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brittany Johnson
• Chandra Johnson
• Daz'Ja Johnson
• Kevin Johnson
• Meloney Denise Johnson, RN
• Yvonne Fry Johnson, MD, MSCR
• Kellie Joiner, LMT
• Jasmin Jones
• Tiara Racquel Jones, MS, OTR/L
• Wyatt Jones, RBT

• Physician Assistant in Martinez, GA
• Providers in Martinez, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.