| Doctor Name: | SHANTEA S. JOHNSON |
| NPI Number: | 1356702054 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, MPH, CHES, CHC |
| License Number: | 19853 |
| Business Practice Address: | 3721 New Macland Rd Ste 200-129 Powder Springs, GA - 301272000 |
| Business Phone Number: | 6787705247 |
| Business Fax Number: | |
| Mailing Address: | 3721 New Macland Rd, Ste 200-129 POWDER SPRINGS |
| State: | GA |
| Postal Code: | 301272000 |
| Phone Number: | 6787705247 |
| Fax Number: | |
| NPI Enumeration Date: | 03/09/2016 |
| NPI Last Update Date: | 03/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133NN1002X |
| License Number: | 19853 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Nutritionist |
| Taxonomy Specialization: | Nutrition, Education |
| Taxonomy Definition: | |