Healthcare Provider Details

I. General information

NPI: 1912192402
Provider Name (Legal Business Name): RALPH H. JOHNSON VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2007
Last Update Date: 09/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 BOGARD ST
CHARLESTON SC
29403-5230
US

IV. Provider business mailing address

91 BOGARD ST
CHARLESTON SC
29403-5230
US

V. Phone/Fax

Practice location:
  • Phone: 850-685-0537
  • Fax:
Mailing address:
  • Phone: 850-685-0537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: MISS ASHLEY MCDANIEL FOGG
Title or Position: PRIAMRY CARE SOCIAL WORKER
Credential:
Phone: 850-685-0537