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General NPI Number Information
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NPI Number | 1801896022
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Entity Type | Individual
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Provider Name | MARY H JOHNSON MD
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Gender | Female
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 02/10/2017
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Provider Practice Location Address
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Address Line | 16000 JOHNSTON MEMORIAL DR 4TH FLOOR
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City | ABINGDON
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State | VA
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Zip | 24211-7664
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Country | US
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Telephone | 276-258-4050
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Fax | 276-258-4056
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Provider Business Mailing Address
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Address Line | 16000 JOHNSTON MEMORIAL DR 4TH FLOOR
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City | ABINGDON
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State | VA
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Zip | 24211-7664
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Country | US
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Telephone | 276-258-4050
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Fax | 276-258-4056
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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 | 207PP0204X
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Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
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License Number | 27331
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207PP0204X
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Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
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License Number | 9401227
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0101052591
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License Number State | VA
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