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General NPI Number Information
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NPI Number | 1174714141
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Entity Type | Organization
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Legal Business Name | ALLIANCE FAMILY PRACTICE, P.C.
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 40 LIBERTY ST
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City | PETERSBURG
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State | VA
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Zip | 23803-5021
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Country | US
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Telephone | 804-862-2878
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Fax | 804-862-2879
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Provider Business Mailing Address
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Address Line | 40 LIBERTY ST
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City | PETERSBURG
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State | VA
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Zip | 23803-5021
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Country | US
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Telephone | 804-862-2878
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Fax | 804-862-2879
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Authorized Official
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Title or Position | FAMILY PRACTICE PROVIDER
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Name | DR. ZELDA WEST JOHNSON
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Credential | M.D.
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Telephone | 804-862-2878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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