Carelle Johnson
Custodial Care Facility in Jesup, GA. Individual provider (NPI-1).
NPI number1831997121
StatusActive
Last updated in NPPESMar 4, 2025
Details
- NPI
- 1831997121
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Carelle Johnson
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Mar 4, 2025
- Last updated
- Mar 4, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 311Z00000X | Custodial Care Facility | CN0036020198 | GA | Yes |
Other names
- Carelle Overstreet (Former Name)
Practice location
158 Kiowa Dr SJesup, GA 31545
Phone 912-424-3204
Mailing address
158 Kiowa Dr SJesup, GA 31545
Phone 912-424-3204
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