MEDICARE: MISS ANDRIA DEE JOHNSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A107237	CA

General Provider Information

NPI Number	:	1225278385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANDRIA DEE JOHNSON M.D.

Provider Business Mailing Address
First Line	:	1450 TREAT BLVD # 300
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94597-2168
Country	:	US
Telephone Number	:	925-952-2888
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 SAN PABLO AVE # 310
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-2498
Country	:	US
Telephone Number	:	510-985-5020
Fax Number	:	510-286-8160

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2009
Last Update Date	:	07/03/2018

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