Laura Johnson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

004660 Issued in GA

Practice address

1111 Glynco Pkwy
Suite 400
Brunswick, GA 31525-7921

Phone

(912) 265-1357

Fax

(912) 265-0495

NPI assigned

Apr 10, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Laura Nicole Stewart Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307491200000",
    "number": "1750504981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 GLYNCO PKWY",
            "address_2": "SUITE 400",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315257921",
            "telephone_number": "912-265-1357",
            "fax_number": "912-265-0495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 GLYNCO PKWY",
            "address_2": "SUITE 400",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315257921",
            "telephone_number": "912-265-1357",
            "fax_number": "912-265-0495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "LAURA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-10",
        "last_updated": "2011-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "004660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "004660",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "STEWART",
            "middle_name": "NICOLE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• John K Weaver, DMD PC
• Chadrika L Johnson, OWNER, CENTER DIRECT
• Deborah F Johnson, RN-BSN
• Evelyn Delois Johnson, M.D.
• Jimmy Wallace Johnson Jr.
• Mallory Harris Johnson, CRNA
• Mark Robin Johnson, DDS
• Steven G Johnson, M.D.
• Tawana Johnson, RN
• William R Johnson, PH.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2011; 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.