Healthcare Provider Details

I. General information

NPI: 1821212481
Provider Name (Legal Business Name): JOHNSON HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 ATHERHOLT RD
LYNCHBURG VA
24501-2148
US

IV. Provider business mailing address

134 ELON ROAD
MADISON HEIGHTS VA
24572
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-6401
  • Fax: 434-528-2639
Mailing address:
  • Phone: 434-455-2480
  • Fax: 434-455-2487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GARY CAMPBELL
Title or Position: CEO
Credential:
Phone: 434-455-2480