Healthcare Provider Details

I. General information

NPI: 1376574988
Provider Name (Legal Business Name): JEFFREY D JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/18/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FAIRVIEW DR
FRANKLIN VA
23851-1238
US

IV. Provider business mailing address

100 FAIRVIEW DR
FRANKLIN VA
23851-1238
US

V. Phone/Fax

Practice location:
  • Phone: 757-569-6100
  • Fax:
Mailing address:
  • Phone: 757-569-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2015-02138
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101238837
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: