Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Gladys B Johnson

Individual provider Family Nurse Practitioner · NPI 1407458102

Gladys B Johnson is a Nurse Practitioner in Stone Mountain, Georgia. Qualified in 2019, 7 years ago. Practices with Blackpool LLC, a 3-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
7
Licensed in
GA
In the registry since
2020
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Practice location Address checks out

3962 Carlinswood Way
Stone Mountain, GA 30083-4776
Phone: (404) 376-2876
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence RN163718 (GA)

Record details

NPI number1407458102
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedNovember 9, 2020
Last updated in NPPESNovember 9, 2020
Certification dateNovember 9, 2020
Mailing address3962 Carlinswood Way, Stone Mountain, GA 30083-4776

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Blackpool Llc — 3 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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