Healthcare Provider Details

I. General information

NPI: 1760564264
Provider Name (Legal Business Name): SONJA MARIA JOHNS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 WEST RIVER RD VIRGINIA CORRECTIONAL CENTER FOR WOMEN
GOOCHLAND VA
23063
US

IV. Provider business mailing address

1383 STOKES STATION RD
GOOCHLAND VA
23063-3809
US

V. Phone/Fax

Practice location:
  • Phone: 804-784-3582
  • Fax: 804-556-2723
Mailing address:
  • Phone: 804-457-4307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101036006
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: