MEDICARE: KENNETH SCOTT JOHNSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101058684	VA

General Provider Information

NPI Number	:	1659388874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH SCOTT JOHNSON M.D.

Provider Business Mailing Address
First Line	:	4444 GERMANNA HWY
Second Line	:	SUITE 310
City	:	LOCUST GROVE
State	:	VA
Zip	:	22508-2035
Country	:	US
Telephone Number	:	540-972-6222
Fax Number	:	540-972-6299

Provider Business Practice Location Address
First Line	:	4444 GERMANNA HWY
Second Line	:	SUITE 310
City	:	LOCUST GROVE
State	:	VA
Zip	:	22508-2035
Country	:	US
Telephone Number	:	540-972-6222
Fax Number	:	540-972-6299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	03/21/2014

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