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General NPI Number Information
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NPI Number | 1295035970
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Entity Type | Organization
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Legal Business Name | ADRIA I JOHNSON, M.D., P.A.
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Dates
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Enumeration Date | 10/27/2010
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Last Update Date | 10/27/2010
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Provider Practice Location Address
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Address Line | 6028 BENNETT RD
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City | JACKSONVILLE
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State | FL
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Zip | 32216-5004
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Country | US
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Telephone | 904-703-4539
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 550788
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City | JACKSONVILLE
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State | FL
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Zip | 32255-0788
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Country | US
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Telephone | 904-703-4539
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ADRIA JOHNSON
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Credential | M.D.
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Telephone | 904-703-4539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081N0008X
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Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | ME0072622
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License Number State | FL
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