Carelle Johnson

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

License

CN0036020198 Issued in GA

Practice address

158 Kiowa Dr S
Jesup, GA 31545

Phone

(912) 424-3204

NPI assigned

Mar 4, 2025

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

Other names 1

• Carelle Overstreet Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1741046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741046400000",
    "number": "1831997121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 KIOWA DR S",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "31545",
            "telephone_number": "912-424-3204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 KIOWA DR S",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "31545",
            "telephone_number": "912-424-3204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "CARELLE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-03-04",
        "last_updated": "2025-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "GA",
            "license": "CN0036020198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARELLE",
            "last_name": "OVERSTREET",
            "credential": "CNA, CMA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jesup Pediatrics, P.C.
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• Jesupcare Anesthesia, PC
• John Lex Kenerly, III, MD
• Ashleigh Lewis Johnson, PAC
• Joy C Johnson, PHARM.D.
• Jones Prescription Shop, Inc.
• Jones Prescription Shop, Inc.
• Alan Millard Jones, R.PH.
• Carey B. Jones II

• Custodial Care Facility in Jesup, GA
• Providers in Jesup, GA by specialty
• Custodial Care Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.