Healthcare Provider Details

I. General information

NPI: 1205320116
Provider Name (Legal Business Name): SONIA AYISI JOHNSON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 CARE WAY STE 200
FREDERICKSBURG VA
22401-8439
US

IV. Provider business mailing address

PO BOX 3339
FREDERICKSBURG VA
22402-3339
US

V. Phone/Fax

Practice location:
  • Phone: 855-739-9953
  • Fax:
Mailing address:
  • Phone: 855-739-9953
  • Fax: 877-916-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0024176163
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: