Individual provider Active NPI

Chanel Antionette Johnson, NP

  • Family Nurse Practitioner
  • Alpharetta, GA
National Provider Identifier
1902792179
Registry record updated Oct 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN337845 Issued in GA
Practice address
3905 Brookside Pkwy Ste 300
Alpharetta, GA 30022-4458
Phone
(770) 442-1911
Fax
(770) 442-0306
NPI assigned
Jun 16, 2025
Last updated
Oct 21, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN337845 GA Primary

Addresses

Primary practice location

3905 Brookside Pkwy Ste 300
Alpharetta, GA 30022-4458

Mailing address

4300 N Point Pkwy Ste 300
Alpharetta, GA 30022-4102
Phone (770) 442-1911

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20250725001915 GA Practitioner - Nurse Practitioner 8628585684 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeast Medical Group, P.C.Group PAC ID 3577559673, 139 clinicians

Practice addresses (Care Compare)

3905 Brookside Pkwy
Suite 300
Alpharetta, GA 30022-4425
Phone (770) 442-1911

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN337845GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Medical Group, P.C. CurrentSince Nov 3, 2025 Accepting new patients
Physician First Health Network PastSince Jun 3, 2025 Accepting new patients

Locations

3905 Brookside Pkwy
Ste 300
Alpharetta, GA 30022
Phone (770) 442-9111

1255 Friendship Rd
Ste 130
Braselton, GA 30517
Phone (678) 341-6350

1800 Northside Forsyth Dr
Ste 450
Cumming, GA 30041
Phone (678) 947-6440

4300 Northpoint Pkwy
Ste 300
Johns Creek, GA 30022
Phone (770) 518-4406

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DIJIBA

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1750032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761004800000",
    "number": "1902792179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 N POINT PKWY STE 300",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300224102",
            "telephone_number": "770-442-1911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3905 BROOKSIDE PKWY STE 300",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300224458",
            "telephone_number": "770-442-1911",
            "fax_number": "770-442-0306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "CHANEL",
        "middle_name": "ANTIONETTE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-16",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN337845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alpharetta, GA

Sources for this page

Verify at the official NPI Registry.