Healthcare Provider Details

I. General information

NPI: 1861339483
Provider Name (Legal Business Name): COLLIN SCOTT JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 CAMPUS DR STE 100
ABINGDON VA
24210-9706
US

IV. Provider business mailing address

312 JOHNSON OAKES RD
DANVILLE VA
24540-8635
US

V. Phone/Fax

Practice location:
  • Phone: 276-525-4487
  • Fax:
Mailing address:
  • Phone: 434-429-6138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: