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General NPI Number Information
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NPI Number | 1780959171
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Entity Type | Individual
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Provider Name | SHELBY JOHNSON D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/19/2012
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 215 WADSWORTH DRIVE
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City | RICHMOND
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State | VA
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Zip | 23236
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Country | US
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Telephone | 804-497-4973
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Fax |
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Provider Business Mailing Address
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Address Line | 7420 JOHNSONVILLE WAY
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-1437
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Country | US
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Telephone | 804-730-2702
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0102049951
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License Number State | VA
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