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General NPI Number Information
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NPI Number | 1285815662
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Entity Type | Organization
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Legal Business Name | CHANDRIA LYNN JOHNSON MD PA
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 05/15/2009
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Provider Practice Location Address
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Address Line | 5950 BERRYHILL MEDICAL PARK DR SUITE B
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City | MILTON
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State | FL
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Zip | 32570
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Country | US
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Telephone | 850-983-2238
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Fax | 850-936-5808
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Provider Business Mailing Address
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Address Line | P.O. BOX 266
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City | MILTON
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State | FL
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Zip | 32572-0277
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Country | US
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Telephone | 850-983-2238
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Fax | 850-936-5808
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Authorized Official
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Title or Position | OWNER
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Name | CHANDRIA LYNN JOHNSON
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Credential |
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Telephone | 850-936-1316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME90117
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License Number State | FL
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