MEDICARE: ATLANTIC FAMILY MEDICINE

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	207QA0505X	Adult Medicine Physician	0101239405	VA

General Provider Information

NPI Number	:	1407253503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC FAMILY MEDICINE

Provider Business Mailing Address
First Line	:	837 FIRST COLONIAL RD
Second Line	:	SUITE B
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6195
Country	:	US
Telephone Number	:	757-493-1965
Fax Number	:	757-544-9873

Provider Business Practice Location Address
First Line	:	837 FIRST COLONIAL RD
Second Line	:	SUITE B
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6195
Country	:	US
Telephone Number	:	757-493-1965
Fax Number	:	757-544-9873

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JASON RYAN JOHNSON
Credential	:	M.D.
Telephone Number	:	757-493-1965

Provider Enumeration Date	:	12/04/2014
Last Update Date	:	04/29/2015

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Directions to “ATLANTIC FAMILY MEDICINE ” Practice Location

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