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General NPI Number Information
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NPI Number | 1093967788
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Entity Type | Organization
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Legal Business Name | VANESSA O. JOHNSON,M.D.,PC
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Dates
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Enumeration Date | 10/14/2008
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Last Update Date | 10/14/2008
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Provider Practice Location Address
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Address Line | 50 MEDICAL PARK BOULEVARD SUITE B
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City | PETERSBURG
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State | VA
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Zip | 23805
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Country | US
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Telephone | 804-732-7100
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Fax | 804-732-7101
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Provider Business Mailing Address
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Address Line | 50 MEDICAL PARK BOULEVARD SUITE B
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City | PETERSBURG
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State | VA
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Zip | 23805
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Country | US
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Telephone | 804-732-7100
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Fax | 804-732-7101
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | VANESSA O. JOHNSON
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Credential | M.D.
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Telephone | 804-732-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0101039958
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License Number State | VA
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