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General NPI Number Information
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NPI Number | 1679628499
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Entity Type | Organization
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Legal Business Name | DR. ZELDA WEST JOHNSON & ASSOCIATES
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 05/24/2011
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Provider Practice Location Address
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Address Line | 101 COWARDIN AVE SUITE 307
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City | RICHMOND
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State | VA
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Zip | 23224-2078
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Country | US
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Telephone | 804-644-5440
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Fax | 804-497-3397
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Provider Business Mailing Address
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Address Line | PO BOX 8001
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City | RICHMOND
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State | VA
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Zip | 23223-0001
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Country | US
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Telephone | 804-644-5440
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Fax | 804-497-3397
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. ZELDA WEST JOHNSON
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Credential | M.D.
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Telephone | 804-644-5440
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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 | 0101057120
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License Number State | VA
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