NPIMap

Individual provider Active NPI

Kwenda Kikora Johnson, P.A.

  • Medical Physician Assistant
  • Hapeville, GA
National Provider Identifier
1801811997
Registry record updated Jan 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
13575 Issued in GA
Practice address
535 N Central Ave
Hapeville, GA 30354-1603
Phone
(404) 761-4040
NPI assigned
Jul 12, 2006
Last updated
Jan 26, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 13575 GA Primary

Addresses

Primary practice location

535 N Central Ave
Hapeville, GA 30354-1603

Mailing address

5753 Jubilant Dr
Rex, GA 30273-1574
Phone (707) 656-6326

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150731017185 CA Practitioner - Physician Assistant 4082613617 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
13575GAMDSpecialist
00351NCMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - Auc PC CurrentSince Dec 1, 2020 Accepting new patients
Community Medical Centers, Inc CurrentSince Jun 23, 2016 Accepting new patients
Open Door Community Health Centers CurrentSince Jul 6, 2015 Accepting new patients
Open Door Community Health Centers CurrentSince Jul 6, 2015 Accepting new patients
Community Medical Centers Inc CurrentSince Jun 23, 2016 Accepting new patients
Union Urgent Care LLC Past Accepting new patients
Carolinas Physicians Network Inc Past Accepting new patients
Carolinas Physicians Network Inc Past Accepting new patients
Carolinas Physicians Network Inc Past Accepting new patients
Carolinas Physicians Network Inc Past Accepting new patients
Union Urgent Care LLC Past Accepting new patients
Carolinas Physicians Network Inc Past Accepting new patients

Locations

1275 8th St
Arcata, CA 95521

2200 Tydd St
Eureka, CA 95501
Phone (707) 441-1624

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 900-3125

7210 Murray Dr
Stockton, CA 95210
Phone (209) 373-2816

730 N Central Ave
Tracy, CA 95376
Phone (209) 820-1500

1601 Ygnacio Valley Rd
Walnut Creek, CA 94598
Phone (925) 295-1545

Interoperability endpoints

  • Direct secure messaging: kwenda.johnson.p2@direct.hvvmg.nextgenshare.com

Organizations & group practices 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769385600000",
    "number": "1801811997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5753 JUBILANT DR",
            "city": "REX",
            "state": "GA",
            "postal_code": "302731574",
            "telephone_number": "707-656-6326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 N CENTRAL AVE",
            "city": "HAPEVILLE",
            "state": "GA",
            "postal_code": "303541603",
            "telephone_number": "404-761-4040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KWENDA",
        "middle_name": "KIKORA",
        "name_prefix": "Miss",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2026-01-26",
        "certification_date": "2026-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "13575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hapeville, GA

Sources for this page

Verify at the official NPI Registry.