Healthcare Provider Details

I. General information

NPI: 1326951336
Provider Name (Legal Business Name): DAVID JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16165 STONEY KNOLL RD
KING GEORGE VA
22485-2908
US

IV. Provider business mailing address

16165 STONEY KNOLL RD
KING GEORGE VA
22485-2908
US

V. Phone/Fax

Practice location:
  • Phone: 540-322-9440
  • Fax:
Mailing address:
  • Phone: 540-322-9440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: