Provider Demographics
NPI:1881416816
Name:JOHNSON, CAROLYN MAUDE (CRNP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MAUDE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:MAUDE
Other - Last Name:MILBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22906 CHERRY HILLS LN
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-8398
Mailing Address - Country:US
Mailing Address - Phone:931-273-4263
Mailing Address - Fax:
Practice Address - Street 1:101 FITNESS WAY STE 2100
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2494
Practice Address - Country:US
Practice Address - Phone:256-262-6190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-166502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty